In medicine, we tend to make complex decisions, and it can be challenging to communicate how we were going about making those decisions to the patients. While we are talking to the patient, we are also actively making decisions which require a significant cognitive load.
Often, the more complex the decision making, the more we end up speaking for ourselves, and not for the patients. We are trying to justify our decisions to the patients and are also justifying them to ourselves in real time. Once you realize that all of this is happening, it is important to zoom out and reflect on your own communication and make sure you are speaking for your audience and not just to your audience.
Given that many of us treat the same conditions over and over, we have ways of explaining complex ideas with patients that we have honed and modified over many visits, and it gets to a point that it does not change very much. This is an advantage in that it decreases our cognitive load. It is important to realize that that extra cognitive energy that has been freed can be utilized to read the room, making sure that the audience is understanding, and changing the course of the discussion as needed. We need to develop this awareness so we can be nimble in our communication.
This freeing up of cognitive energy by developing our discussions, or spiels, to use a Yiddish term with no equivalent term in English, is something that has evolved in humans because we have finite cognitive energy, so we need to protect it.
We are cognitive misers. In order to conserve that cognitive energy, we develop biases and heuristics from our training, experience, and continued education. Sometimes these biases can be disadvantageous. This is discussed in other blog posts. In medicine, we use them to solve problems quickly. As we go through our training and gain experience, we identify patterns, which allow us to make diagnoses and treatment decisions much more rapidly. Sometimes there is no ambiguity about the diagnosis and management. The challenge is recognizing when we may be jumping to conclusions too quickly. Is there more data that may challenge our diagnosis? In that situation, it is important to order that extra lab test, imaging study, or send the patient to see that consultant in order to make sure that you are not relying too heavily on heuristics. It is also important to communicate with the patient the uncertainty of some diagnoses so that it leaves the door open for them to follow-up.
Would we be open to changing the diagnosis if it were challenged?
The IKEA effect is when we overvalue our own work. We will want to sell a product for more money if we put it together ourselves, like IKEA furniture. The same applies to a diagnosis. If we put in the work to assess a patient, we tend to overvalue our own conclusions. We need to be ready to recognize when we are incorrect and course correct and explain all of that decision making to the patient, which is more easily done if we’ve been effectively communicating uncertainty along the way.