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Cognitive biases cloud our clinical decisions and patient expectations: A narrative review to help bridge the gap between evidence-based and personalized medicine - 05/08/22

Doi : 10.1016/j.rehab.2021.101551 
Boris Gojanovic a, b, , François Fourchet a, Vincent Gremeaux c, d
a Sports Medicine and Rehabilitation Department, Swiss Olympic Medical Center, Hôpital de La Tour, Meyrin, Switzerland 
b Centre SportAdo, Woman-mother-child Department (DFME), Lausanne University and Hospital, Switzerland 
c Swiss Olympic Medical Center, Sport Medicine Unit, Lausanne University Hospital, Lausanne, Switzerland 
d Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland 

Corresponding author at: Sports Medicine and Rehabilitation Department, Swiss Olympic Medical Center, Hôpital de La Tour, Meyrin, Switzerland.Sports Medicine and Rehabilitation DepartmentSwiss Olympic Medical CenterHôpital de La TourMeyrinSwitzerland

Highlights

Cognitive biases are prevalent in sports medicine and cloud our decisions.
Patients and athletes can have magical expectations of quick fixes.
Clinicians must learn about cognitive biases and mitigation strategies in schools.
Slowing down decision-making and considering alternative diagnoses can be effective.
Know your own cognitive biases and use checklists to limit the impact on decisions.

Le texte complet de cet article est disponible en PDF.

Abstract

In sports medicine and rehabilitation of musculoskeletal conditions, training, knowledge and expertise of clinicians are the guarantors of good clinical practice. But are they really? Since the 1970s, a growing body of sociological and behavioral science has developed the concepts of cognitive biases and thinking errors. In a nutshell, it tries to explain how we approach decision-making using shortcuts, or heuristics. Our brains will alternatively use 2 systems to think and decide: system 1 is fast, intuitive and emotional, whereas system 2 is slow, logical and conscious. We may think clinicians use the latter systematically, but they actually use system 1 in many situations. Whether due to intrinsic thinking errors or external forces that cloud our judgment, we are under unconscious influences and so are all the stakeholders in the rehabilitation setting, including the patient/athlete. We present some of the most prevalent biases that pervade clinical decision-making and attempt to give a bit of background context starting from the typical tension between academic authority and personal experience. The field of sports performance is also riddled with beliefs, egocentrism and a general tendency to search for magic bullets that will bring the marginal gains and edge over the competition. This plays into the rehabilitation of patient-athletes in different ways. Finally, there are ways to mitigate the effect of cognitive biases to improve decision-making. This must include better communication, shared decisions and ultimately the understanding that we should drive our profession to deliver high-value care tailored to the patients, in line with the best evidence at the best possible cost. Hopefully, we can shed some light without too many of our own biases on the complexities of thinking in sports medicine and rehabilitation.

Le texte complet de cet article est disponible en PDF.

Keywords : Cognitive bias, Sports, Rehabilitation, Decision-making, Interdisciplinarity


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Vol 65 - N° 4

Article 101551- juin 2022 Retour au numéro
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