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Posts Tagged ‘hindsight bias’

Branding & Brand Loyalty

How does self image tie to brand loyalty?  Can we tie that to PT?

So I’ve started reading for fun again, finally.  I enjoy reading about incentives and decision making. The human capacity to fool itself amazes me.    My first brain-toy is this:  You Are Not So Smart.  It started as a blog written by @davidmcraney.  He’s a journalist who writes about things that are fun and interesting.  I recommend checking out the blog or book!  

One chapter in his book stood out as relevant to some of the #SolvePT discussions. Craney pointed out that brand loyalty is created from buying (or buying into) unessential things – iPads or your favorite brand of smart phone. To oversimplify his point, spending a lot on something you don’t need forces you to create a narrative in your mind about why you made the best decision for you.  A higher cost means a stronger internal justification.  It sounds to me like the effect lies somewhere between cognitive dissonance and confirmation bias.  Your unconscious interests in justifying your decisions tie directly to your own self image.  You are forced, after making the decision, to create a narrative supporting the decision. And ownership reinforces the emotional connection to “stuff.”

Can physical therapy be stuff? Should it be?  Probably NOT.  I feel like the fact that we do not create the same brand loyalty to PT is a testament to our USEFULNESS.  Not to say that an iPad can’t be useful,  but when you need physical therapy you definitely NEED physical therapy.  You never really NEED a new tablet. I am probably reaching here, but the idea of entitlement to PT via health insurance, and a client/patient’s reluctance to pay for PT out of pocket definitely hurts our cause.  You lose the benefit of cognitive dissonance.  I am paying for PT, so I must value it!  

What’s weird to me is the attachment people have to their chiropracters.  Does that the kind of brand loyalty Craney describes insinuates an unthinking devaluation of chiropractic care?  Craney also points out that for brand loyalty to occur, you must have OPTIONS, or a decision to make.  Reducing the # of options reduces buyer’s remorse.  People LOVE their chiropracters and accupuncturists, and pay out of pocket for other services because they KNOW they have a choice!  The public is aware that they can go to a chiropracter first.  


Lets see if I can tie this together to make my point.  I am NOT saying we need to create a preception that people don’t need us so that they have to justify going to see a physical therapist.  I’m saying we need to increase AWARENESS that we are a CHOICE, not just a place patients go because the workman’s comp physician sent them to us. We need to give patients/clients/the public the opportunity to make [the right] decision about PT to allow self-image-affirmation to take over.  I think, too, that building a client/patient a reason to be more comfortable paying out of pocket will strengthen this bond.  Is this even possible???

Is anybody having success trying to create a self-paying base of patients/clients?

Thinking about Thinking

When I started PT school, I knew this is where it would take me.

Bad joke.  Let me explain.

Spent my whole life ignoring things like metacognition, because I preferred more discrete sciences. Love answers. Real answers.  But have, slowly, become enamored with social science and why we think and do the silly things we think and do, and how behaviors and thinking change over time.  Like a playground for my brain!  Errors in thinking… I make a great many errors.

What caught me about this, and why I decided to join the conversation on soma, is a book I’ve been reading about cognitive errors in the assumptions we create constructs of ourselves and the world around us.  The chapters on Hindsight bias and Confirmation bias have taken a lot of my brain power lately.  The book is “You are Not So Smart.”

I suspect that some errors in clinical decision making come from the minds innate need to make sense of the world quickly to move on to the next stimulus.

Clinicians are trained (I just finished school, but hope never to finish training) to rely on “clinical decision making.”  Human make decisions, which are subject to every kind of bias I’ve ever heard of.  Confirmation bias and hindsight bias (narrow spectrum, I know) work together to affirm our mistakes in thinking.  A perfect storm for error!  Hindsight works like this: an event/result/outcome happens.  In reflection, certain events stand out leading up to the incident.  You, being the reflective practitioner you were trained to be, try to construct patterns from randomness.  This is where it falls apart. Hindsight bias is “I knew it all along”.  It’s ignoring how you were wrong previously – taking from coincidence facts and ignoring other data to convince yourself you expected the outcome.   Confirmation bias is “I bought a honda, now all I see is hondas!  I must have bought a great car!”

The worst errors are of oversimplification (for the intent to do good!) of complex models to simpler ones.  This allows them to “see more” and explain more, and rationalize their own clinical decision making. To say “I knew that you would respond to ____” all along.  And a strong bias from then on to find evidence to SUPPORT instead of refute their newly constructed world view.  Confirmation bias is the reason my dad woke up every morning at 5AM to listen to Rush with his morning news before work (politics aside).  People look seek out things that agree with their world view to validate what they are already thinking.  Couple that with a strong hindsight bias and you have the recipe for a guru.  I will explain.  A guru isn’t believable because they are good liars.  They whole heartedly believe that what they are telling you about piezoelectric effect when, in reality, most of what they are saying sounds very plausible because of a very plausible sounding model of electricity.  Or biomechanical models of spine pain. Or justification for ultrasound.  Craniosacral therapy.   I digress.

I am intrigued by the capacity of the brain to justify just about everything.  Including writing this post.

It’s worth noting that I have not even passed my board exam yet.   Turns out I know a lot about neuro, musculoskeletal, and “other systems.”  But less about the foundational sciences of the cardio/pulm system and next to nothing about modalities.  3 of those things are interesting to me.  2 of them bore me to tears.  One of them, as a category of intervention, is mostly crap (so far as my education is concerned, but more independent research on my part should be done). Care to guess which one it is?

Also, I could use a good recommendation for a “review cardio for the NPTE” book, if anyone has anything. Thanks.

-d