“How do I minimize confirmation bias?” was a question directed to me by my current doctoral intern.
The terminology was brought to his attention after I told him that a patient being seen for initial evaluation did not achieve the best treatment due to his preconceived confirmation bias. What led to this conversation?
-He told me prior to seeing a patient, by just reading medical history report (specifically activities that are deemed difficult to the individual), that considering the individual had difficulty in sustained positions (such as sitting, standing and walking); that the patient would fit the bill for a stabilization program. He just “knew” this would help her.
– Now, I am all about having an initial hypothesis just from medical history and body diagram, but the subjective history and objective findings should refute or confirm your hypothesis.
– Confirmation bias, even if findings refute your hypothesis, will deter the clinician from applying appropriate interventions based on preconceptions.
– Now granted, he was able to “back it up” per Delitto et al’s Clinical Practice Guidelines for Low Back Pain; but what does latest meta analysis say with strong concluding statement? Plus, we need to be aware of all 3 pillars of EBP and don’t jump to conclusions too quickly.
In his case, his mind was on a railroad track to just stabilizing the patient without having options. You know how much I am not on board with this anyway 🙂 Therefore, he did not perform the appropriate history taking and objective findings to refute his findings, just found what he wanted to confirm what he already thought. Therefore, he fit the bill of a saying, “you will always find what you are looking for”.
So his question to me was, “how do I minimize confirmation bias”
1. Firstly, you need to be aware of your confirmation bias. You can’t change what you are not currently aware of.
2. You can’t avoid it, but you can minimize it.
3. You have to be exposed to multiple intervention disciplines and approaches. My current intern was preached stabilization in school, past CIs did not teach him anything else but to “use what he knew”, so he is unaware of manipulation, dry needling, and directional preference.
4. Not only being exposed to different paradigms, you need to practice and create patterns within these paradigms. In theory, this would create more confirmation biases, but then again, it will allow you build a strong foundation that holds up the 3 pillars of EBP.
This is a start. What are your thoughts? How do you minimize confirmation bias?