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Overconfidence as occupational hazard April 26, 2007

Posted by Sharath Rao in ideas, india.
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A friend and blog reader Dr. Ashwini Shenoy mentioned recently that its been a while since I ‘took on’ doctors. Well, not that I particularly ‘take on’ them or even ‘take on’ them at all, but this time I think I am 😉 or at the least, I am linking to someone who is.

But docs are taught more medicine than nurses; why are they no better at primary care? Probably because docs are famously overconfident. For example, one study found that on average when docs were 88% confident that their patient had pneumonia, in fact only 20% of such patients had pneumonia. And overconfidence is fatal in primary care.

It is the same in primary care; most patients are simple and boring: sniffles, rashes, and so on. Doctors, nurses, or paramedics can all do primary care well if they know when they do not know, i.e., if they can recognize signs that a patient is unusual, and should be referred to a specialist. And this is where overconfidence is fatal. Someone who knows less medicine, but admits when they do not know, can do as well as someone who knows more, but is overconfident.

Overconfidence is ofcourse going to hurt just about anywhere, but do we have reason to believe that certain professionals ( in certain context – cultures/healthcare systems) are systematically more overconfident than others. Actually, I don’t even know if we can begin to measure phenomena like overconfidence across professions. So lets leave it there.

I don’t ofcourse want to hit and run, not take a stand and be ambivalent about everything. Hence I state that from personal experience I found that if I tell doctor A about doctor B’s diagnosis, doctor A either adds to B’s explanation, or corrects it or mentions an exception to B’s explanation. (my own brother/aunt/cousin/friends included ). So are doctors fiercely competitive in the part of the world I come from ? Is one example enough at all to make such a sweeping conclusions ? But that appears to be true of cricketers too ? And computer programmers ? And economists ? Linguists perhaps ? So am I just singling out doctors ?

Note : I know it depends on specific individuals but I am talking about average behavior.

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