#PhysioTalk Transcript

Healthcare social media transcript of the #PhysioTalk hashtag.
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physiotalk @physiotalk
The chat is being hosted by our guest Dr Zachary Walston @zachwalston who serves as the national director of quality and research at PT solutions. #physiotalk
physiotalk @physiotalk
@zachwalston #physiotalk ;)
physiotalk @physiotalk
@zachwalston Great to have you! But a reminder to use the hashtag in your tweets please otherwise we might not see them! #physiotalk
physiotalk @physiotalk
@zachwalston has presented at multiple conferences on his research and the impact of cognitive biases on clinical decision making and patient outcomes. #physiotalk
Sibyl Edward, D.P.T. @pasl_pt
@physiotalk @zachwalston Hi. I am Sibyl. Tweeting from St. Lucia. Interesting topic given that we as PTs are constantly making decision impacting patients' lives.#physiotalk
Saffron @SaffThePhysio
Excited for this discussion with @physiotalk and @zachwalston
physiotalk @physiotalk
Welcome all that have currently joined. Please start by letting us know when in the world you are tweeting from! As always, please don’t forget to use #physiotalk in all your tweets so everyone can follow the conversation.
ThePhysioBack @physio_back
@physiotalk Hi. David a student PT down in Bournemouth. #physiotalk
Saffron @SaffThePhysio
@physiotalk Following from london #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk Lurking in the background from stoke! Tad distracted. #physiotalk
Janet Thomas @JanetThomas47
@physiotalk I'm in the background tonight from a dreich Edinburgh making sure you all remember to use the hashtag :) #physiotalk
Zachary Walston @zachwalston
@PT_Solutions
physiotalk @physiotalk
@S0uthernUpN0rth @zachwalston Don't forget the #physiotalk please!
Dale Whelehan @Daleyfurter
@physiotalk Hi all! Dale from Ireland 🇮🇪 . Great to see cognitive biases being discussed! Looking forward to seeing research in the area. Shameless plug here of my own research on cognitive bias and heuristics in medicine which may be of interest to some: https://t.co/4j7ZVq6Dn5 #physiotalk
physiotalk @physiotalk
@IanTyrrell5 Welcome (distracted by what....) #physiotalk
physiotalk @physiotalk
@physio_back Hi David! #physiotalk
physiotalk @physiotalk
Shameless plugs welcome! #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk Trying to cook dinner, watch football...typical Monday evening! #physiotalk
physiotalk @physiotalk
Right, lets get started! #physiotalk Q1: What is an example of confirmation bias you have experienced in a healthcare setting? Could be clinician or patient.
Zachary Walston @zachwalston
Love seeing this research. We need to educate students in this area. They are foundational concepts to layer clinical information on. We must learn how to think first.
Ian Tyrrell @IanTyrrell5
@physiotalk This is what the referral says so it must be it and I must treat it like that.... #physiotalk
physiotalk @physiotalk
#physiotalk
Dale Whelehan @Daleyfurter
@physiotalk Confirmation bias= ‘tunnel-visioned’ searching to support initial diagnoses while ignoring potential data which will reject initial hypotheses - in this case, could be diagnosing with non-specific back pain & missing salient atypical features of a something different #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk Which often leads me to think I’m going to try and find something different just to be awkward! #physiotalk
Janet Thomas @JanetThomas47
@IanTyrrell5 @physiotalk Do you get a lot like that? I do remember many many years ago that was the norm mind... #physiotalk
physiotalk @physiotalk
#physiotalk
Zachary Walston @zachwalston
@IanTyrrell5 @physiotalk I like the mindset of Charlie Munger: “I never allow myself to hold an opinion on anything that I don't know the other side's argument better than they do” #physiotalk
Dale Whelehan @Daleyfurter
@zachwalston Indeed! We talk a lot about reflective practice, clinical reasoning which are reflective processes developed through engagement in CPD. We don't focus enough on protecting against shortfalls in intuitive decision making #physiotalk
physiotalk @physiotalk
RT @Daleyfurter: @physiotalk Confirmation bias= ‘tunnel-visioned’ searching to support initial diagnoses while ignoring potential data whic…
Sibyl Edward, D.P.T. @pasl_pt
@physiotalk Q1. The LBP with sciatica that is nothing but a LBP which turns out to be something more sinister. #physiotalk
Ian Tyrrell @IanTyrrell5
@JanetThomas47 @physiotalk In my old job in ED as a therapist yes! And often upon physical assessment was something completely different! The benefit of experience and type 2 thinking! #physiotalk
Laura Rathbone🌱✌🇪🇺🌈 @laurarathbone
@physiotalk Hoping to be able to keep checking in from Amsterdam:) #physiotalk
Dale Whelehan @Daleyfurter
@pasl_pt @physiotalk I had a very similar example! I think back pain is one of those areas of practices we could be most prone #physiotalk
physiotalk @physiotalk
A reminder as we start with the questions to include the hashtag in all of your tweets tonight It allows people to follow the chat AND without it your tweets won't appear in the transcript either #physiotalk https://t.co/lpuYG2kXaK
Sibyl Edward, D.P.T. @pasl_pt
@Daleyfurter @physiotalk @Daleyfurter, any luck of a PDF #physiotalk.
Lewis Lovegrove @_lewadam
@IanTyrrell5 @physiotalk Referral - stiff shoulder so must be a frozen shoulder. Turns out when asked patient can passively take arm into full range 🤔. #physiotalk
Laura Rathbone🌱✌🇪🇺🌈 @laurarathbone
RT @Daleyfurter: @physiotalk Hi all! Dale from Ireland 🇮🇪 . Great to see cognitive biases being discussed! Looking forward to seeing resear…
J. Martin Nunez silveira @JmNunezSilveira
🤔 Can we diagnose asynchronies through the excursion of the diaphragm? #physiotalk #Fisioterapia #fisioterpaeutas #POCUS #LUS #some4mv @physiotalk @POCUSAcademy @Pocus101 @sonophysio https://t.co/UimTsoqdQR
Zachary Walston @zachwalston
If you use dry needling, research all the reasons why you shouldn’t and try to convince yourself. If you can’t, great, you now understand the technique better. If you end up convincing yourself, drop the tool. No tool is undroppable. #physiotalk
Zachary Walston @zachwalston
#physiotalk One of my favorite quotes that I often refer to is from the book, how not to be wrong: the power of mathematical thinking. The author, Jordan Ellenberg writes, “When you’re working hard on a theorem you should try to prove it by day and disprove it by night.”
Zachary Walston @zachwalston
He is a mathematician, so theorems are his game, but the same concept anywhere. The best way to combat a confirmation bias is to try proving yourself wrong. I experience the most clinical growth when I research the opposite side of my current treatment approach. #physiotalk
Sibyl Edward, D.P.T. @pasl_pt
@Daleyfurter @physiotalk Just had a case and turned out to be mets!!! #physiotalk
ThePhysioBack @physio_back
@Daleyfurter @zachwalston When I trained as a Chiro, one of our lecturers said we should always sprinkle some doubt on our clinical reasoning, just to keep an open mind #physiotalk
Graeme Paul-Taylor @GraemeGpt
@physiotalk Nothing quite like coming off a course and then finding that everything fits and works! Shame it doesn't last #physiotalk
C Harris @CHarrisPhysio
@physiotalk Maybe occasions when a particular treatment / intervention has not worked being attributed to another (potentially irrelevant) factor, and thus the memory of that treatment not working being discounted when considering treatment options for other people in future #physiotalk
Dale Whelehan @Daleyfurter
@pasl_pt @physiotalk Oh how sad for all involved! #physiotalk
Zachary Walston @zachwalston
@JanetThomas47 @IanTyrrell5 @physiotalk Confirmation bias is still one of the primary biases I see in the clinic. It can worsen with experience as inuition and anecdotal experience takes center stage #physiotalk
Dale Whelehan @Daleyfurter
@physio_back @zachwalston That is a great mantra! Even being aware if you are using Type 1 or Type 2 thinking is a useful in exercising judgement #physiotalk
physiotalk @physiotalk
I think I might keep a book of quotes from tonights #physiotalk Some great ones so far: "No tool is undroppable" "Sprinkle some doubt on our clinical reasoning"
Lewis Lovegrove @_lewadam
@Daleyfurter @pasl_pt @physiotalk Indeed! The pyscho-social undeniably important, but not before the bio has been explored. #physiotalk
Sibyl Edward, D.P.T. @pasl_pt
@Daleyfurter @physiotalk Which is why this topic is so important! #physiotalk.
ThePhysioBack @physio_back
@Daleyfurter @zachwalston Sorry, what's Type 1 and Type 2 thinking? #physiotalk
physiotalk @physiotalk
Great stuff! Lots to discuss so…#physiotalk Q2: What is the most common bias you fall victim to?
Zachary Walston @zachwalston
@_lewadam @IanTyrrell5 @physiotalk This is also a representative heuristic. Sometimes heuristics are beneficial but they can caused us to make decisions prematurely and miss information. Satisfaction of search is an issue to be wary of. #physiotalk
Janet Thomas @JanetThomas47
@zachwalston @IanTyrrell5 @physiotalk Do you think we are more prone to bias when we use pattern recognition model of clinical reasoning perhaps? #physiotalk
Zachary Walston @zachwalston
@physio_back @Daleyfurter Type/system 1 is a our fast, inutitive, bias/heuristic driven thinking while type/system 2 is our slow critical thinking process #physiotalk
Lewis Lovegrove @_lewadam
@physiotalk Encouraging +++ exercise and movement for everything 🤷🏼‍♂️ #physiotalk
Dale Whelehan @Daleyfurter
@physio_back @zachwalston Here is a good infographic! Typically we use Type 1 thinking in our day to day life in making quick decisions of low cognitive load. Type 2 thinking i.e. reflective and clinical reasoning is when effort is required and increased cognitive load. Both serve purposes!#physiotalk https://t.co/4gZrTgwnAK
Zachary Walston @zachwalston
@Daleyfurter @physio_back https://t.co/14dFjc38Y6 #physiotalk
Janet Thomas @JanetThomas47
@GraemeGpt @physiotalk I think we all know that feeling! #physiotalk
physiotalk @physiotalk
RT @zachwalston: @physio_back @Daleyfurter Type/system 1 is a our fast, inutitive, bias/heuristic driven thinking while type/system 2 is ou…
physiotalk @physiotalk
RT @Daleyfurter: @physio_back @zachwalston Here is a good infographic! Typically we use Type 1 thinking in our day to day life in making qu…
Zachary Walston @zachwalston
@Daleyfurter @physio_back Scientific curiosity is one of the most powerful traits an clinician can possess. #physiotalk.
Graeme Paul-Taylor @GraemeGpt
RT @zachwalston: @Daleyfurter @physio_back https://t.co/14dFjc38Y6 #physiotalk
Ian Tyrrell @IanTyrrell5
@JanetThomas47 @zachwalston @physiotalk For me no! Patterns are fine, but it’s understanding person centred care and what works for that individual! My mantra is two people of the same age with the exact same condition may present completely differently! Get to know your patient and be suspicious! #physiotalk
Zachary Walston @zachwalston
@GraemeGpt @physiotalk Ha, very true. It's amazing how after someone gets certified in dry needling, everyone is a prime candidate. #physiotalk
Sibyl Edward, D.P.T. @pasl_pt
After 30 years of practice, I would jump at overconfidence bias. My choice...#physiotalk
@SoMe4MV @some4mv
RT @JmNunezSilveira: 🤔 Can we diagnose asynchronies through the excursion of the diaphragm? #physiotalk #Fisioterapia #fisioterpaeutas #POCUS #LUS #some4mv @physiotalk @POCUSAcademy @Pocus101 @sonophysio https://t.co/0ewrICj6ag
Dale Whelehan @Daleyfurter
@physio_back @zachwalston Of course it is important to recognise how human factors (e.g. culture, fatigue, other environmental stressors) increase cognitive load also and impact our ability to differentiate which type of thinking to utilise - resulting in improper use of 'Type 1' heuristic #physiotalk
Janet Thomas @JanetThomas47
@_lewadam @physiotalk Me too - is that a bias or a good thing? I'm sure all of my older patients benefit from exercise and movement - don't they????!!! #physiotalk
Lewis Lovegrove @_lewadam
@JanetThomas47 @physiotalk 100% both! Which suits my bias 😆#physiotalk
physiotalk @physiotalk
#physiotalk
Rehab for All South Africa @RehabforAllSA
"I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail" Abraham Maslow #physiotalk
Dale Whelehan @Daleyfurter
@physiotalk Quite a few depending on context! I think 'availability bias' in outpatient settings plays a big role, 'representative bias' in inpatient settings, and maybe overconfidence bias in my research 🤪 #physiotalk
Zachary Walston @zachwalston
#physiotalk Most common biases I see are the sunk-cost fallacy and availability heuristic. The culture of our practice, the training available, courses we attend, the school we graduated from influence our thinking . Sunk-cost amplifies our commitment to the past investments.
physiotalk @physiotalk
RT @zachwalston: #physiotalk Most common biases I see are the sunk-cost fallacy and availability heuristic. The culture of our practice, th…
physiotalk @physiotalk
RT @RehabforAllSA: "I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail" Abraham Masl…
physiotalk @physiotalk
Okay, moving on! #physiotalk Q3: How do you confront someone clearly demonstrating a cognitive bias or fallacy when having a clinical debate?
Dale Whelehan @Daleyfurter
@zachwalston It is interesting you speak of sunk-cost fallacy and I think you might find that more prevalent in the USA and UK because of the higher academic fees. I'd say in other European countries it doesn't feature as strongly #physiotalk
Zachary Walston @zachwalston
@Daleyfurter @physiotalk It's interesting how some have an overconfidence bias while others experience the opposite. I have seen clinicians fearful to act and display a type of loss aversion (I knew I shouldn't have tried that new technique) when confidence is low. #physiotalk
ThePhysioBack @physio_back
@Daleyfurter @zachwalston Interesting. In the time I spent as a teacher, I know it was very hard to get students to move to Type 2 thinking. They really stayed in Type 1, so see how it can become a habit #physiotalk
Saffron @SaffThePhysio
@physiotalk Thinking that treatment X is better to try than treatment Y, because it worked on another patient/EBP says so #physiotalk
Zachary Walston @zachwalston
@Daleyfurter Absolutely. But sunk-cost can be investment in time and effort as well. We may be resistant to abandon a technique or mindset because of past investment. #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk I find others become foul of anchoring! I am over suspicious at times and try my best to use my own knowledge to confirm rather trusting another individual! Rightly or wrongly! #physiotalk
ACPSEMdance @ACPSEMdance
RT @Daleyfurter: @physio_back @zachwalston Here is a good infographic! Typically we use Type 1 thinking in our day to day life in making qu…
Janet Thomas @JanetThomas47
@zachwalston @Daleyfurter Yes - we don't have UG fees for our home students on Scotland, but if you have personally paid for a course then I'm sure that has an effect! #physiotalk
Dale Whelehan @Daleyfurter
@physiotalk Plenty of ways to address biases: 1. Skills development and reflective practice (to reduce over reliance on limited information) 2. Training and simulation and 'cognitive forcing' situations (i.e. confronting your own biases) 1/? #physiotalk
physiotalk @physiotalk
#physiotalk
Sibyl Edward, D.P.T. @pasl_pt
@IanTyrrell5 @physiotalk I would agree as well. At the end of it all, if we can analyze what we anchored on and redirect from there, then all isn't loss. #physiotalk
ThePhysioBack @physio_back
@zachwalston @Daleyfurter @physiotalk Funnily I had this with dry needling. I dislike needles, so disliked using it with people. So avoided using it, so lost confidence, so avoided it further. Only ever did it for superficial muscles if people really asked for it/to try something else. #physiotalk
Zachary Walston @zachwalston
#physiotalk “A rational decision maker is interested only in the future consequences of current investments. Justifying earlier mistakes is not among the Econ’s concerns.” – Daniel Kahneman in Thinking, Fast and Slow Thoughts on the sunk-cost fallacy. Substitute physio for econ
Saffron @SaffThePhysio
RT @Daleyfurter: @physio_back @zachwalston Here is a good infographic! Typically we use Type 1 thinking in our day to day life in making qu…
Abel Abrego @Abelgavino
RT @JmNunezSilveira: 🤔 Can we diagnose asynchronies through the excursion of the diaphragm? #physiotalk #Fisioterapia #fisioterpaeutas #PO
Dale Whelehan @Daleyfurter
@physiotalk 3. Technology for pattern recognition to assist decision making 4. Shared decision-making with patients 5. Culture change and open disclosure in human factor issues (e.g. fatigue) and in error-making #physiotalk 2/2
محمد الشمّري @MohAlshammary
RT @some4mv: RT @JmNunezSilveira: 🤔 Can we diagnose asynchronies through the excursion of the diaphragm? #physiotalk #Fisioterapia #fisiot
Jo Kitchen @J0Physio
@zachwalston @physiotalk That’s really interesting. I hadn’t thought of sunk-cost fallacy in relation to treatment before! I wonder if it happens re: rx length, having spent so much time working with a pt who isn’t achieving their goals but keep trying without reassessing? Or is that diff?#physiotalk
Lewis Lovegrove @_lewadam
@physiotalk I suppose this can be challenging, especially if considered less experienced. Be polite, explore beliefs together and challenge respectfully. #physiotalk
Janet Thomas @JanetThomas47
@physiotalk I'm getting tortured in my thinking here. How do I know its them with the bias and not me.... #physiotalk
Dale Whelehan @Daleyfurter
@zachwalston @physiotalk Important also to note biases are inevitable and ultimately allow us to 'function' in our lives. We wouldn't be able to make day-to-day decisions without them! But ultimately about recognising their inappropriate use and potential for harm #physiotalk
Zachary Walston @zachwalston
@JanetThomas47 @physiotalk We all are prone to bias. I think it is better to focus on yourself rather than others. That actually plays into the third question #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk This depends on grade and profession (although it shouldn’t) but should be done professionally, not confrontational and a sharing of relevant clinical information and evidence as applicable! #physiotalk
Dale Whelehan @Daleyfurter
@physio_back @zachwalston @physiotalk Of course other variables at play here such as Dunning-Kruger effect with regards to risk of having overconfidence bias #physiotalk https://t.co/TeWkixpJGn
Janet Thomas @JanetThomas47
@J0Physio @zachwalston @physiotalk Good question! I think it probably is the same bias deep down #physiotalk
Sibyl Edward, D.P.T. @pasl_pt
A bit of discussion and education devoid of confrontation #physiotalk
physiotalk @physiotalk
Next question… #physiotalk Q4: How can cognitive fallacies, biases, and heuristics best be integrated into clinical education?
Rehab for All South Africa @RehabforAllSA
What of the strong bias towards hands on therapy and manual techniques over broader interventions addressing the biopsychosocial causes of pain, injury and disability? #physiotalk
Dale Whelehan @Daleyfurter
@JanetThomas47 @zachwalston Absolutely - particularly as the evidence base for physiotherapy continues to change and evolve. Even culturally between the USA and Europe, physiotherapy practice differs greatly #physiotalk
Jo Kitchen @J0Physio
I think this discussion is key & exploring what those beliefs look like in case studies and actual practice can help work through where bias is apparent #physiotalk
Zachary Walston @zachwalston
@J0Physio @physiotalk It is absolutely a part of it. Sunk-cost is not exclusively financial cost. Time and effort are large components. Learn from the past but focus your actions on the future. #physiotalk
Janet Thomas @JanetThomas47
@IanTyrrell5 @physiotalk Def not confrontational - professional discussion in an open manner best I think #physiotalk
Saffron @SaffThePhysio
@physiotalk I think it's difficult as a student, finding the right way to have these conversations with superiours without treading on any toes or coming across as rude. Therefore it is something that takes practice and building a good rapport to highlight any issues #physiotalk
Zachary Walston @zachwalston
@Daleyfurter @physio_back @physiotalk I recall being chief of "mount stupid" as a resident... #physiotalk
Ian Tyrrell @IanTyrrell5
@JanetThomas47 @physiotalk But it’s all about personal awareness, tone, body language, situational awareness. Need training in this too! #physiotalk
Zachary Walston @zachwalston
@Daleyfurter @physio_back @physiotalk And then the first patient I hurt knocked me straight into the valley of dispair. The joys of residency. #physiotalk
Janet Thomas @JanetThomas47
@Daleyfurter @zachwalston Its very different world wide - I see that with my @IPTOPphysio role I do think there are more similarities than differences though overall #physiotalk
Saffron @SaffThePhysio
@physiotalk 2/2 Perhaps this is something that could be encouraged more in university to make it easier to have these conversations in practice? #physiotalk
Dale Whelehan @Daleyfurter
@physiotalk 1. Train the trainer (important to differentiate here between 'education' which is the theoretical understanding of a concept and 'training' i.e. imparting a set of skills or 'toolkit' for practitioners to use) 2. Have peer review of where biases are identified #physiotalk
Jo Kitchen @J0Physio
@physiotalk Case studies! And stories, narratives help so much in showing bias #physiotalk
Zachary Walston @zachwalston
@pasl_pt I struggle with this sometimes. Fact punching doesn’t work. Some people view bias and heuristics as theoretical. They only want hard numbers. Another response is digging heals in. I find the best strategy is to seek understanding and ask more questions. #physiotalk
Lewis Lovegrove @_lewadam
@physiotalk Case studies, same presentations with differing treatment methods...discuss! #physiotalk
Ian Tyrrell @IanTyrrell5
@physiotalk Decision making and biases imo should be taught on undergraduate programmes (albeit they are already rammed). I learnt about it from my own reading before a masters module! #physiotalk
Dale Whelehan @Daleyfurter
@physiotalk 3. Work as 'partners' with students providing them with effective modelling of when best to use heuristics. Discuss scenarios with students about own personal experiences with biases in clinical practice and create a 'cognitive roadmap' for students to aid DM #physiotalk
C Harris @CHarrisPhysio
@physiotalk A good start may be teaching that they exist / what they are, with reassurance that everyone is subject to them, but you can over-rule them in yourself if you are aware of them and make a conscious effort to do so #physiotalk
Saffron @SaffThePhysio
@physiotalk Observing/assisting others and how they would treat a condition, treating different patients and learning on the job, research and case studies #physiotalk
Lewis Lovegrove @_lewadam
@IanTyrrell5 @physiotalk As a student you can fall victim to finishing uni with an unintentional bias of what you have been taught is gospel! #physiotalk
C Harris @CHarrisPhysio
@J0Physio @physiotalk Also maybe getting students to work through example scenarios where 1 or more biases / fallacies / heuristics are in play #physiotalk
Zachary Walston @zachwalston
@IanTyrrell5 @JanetThomas47 @physiotalk Agree on both. Simply pointing out a bias doesn’t necessarily work as it can still come across as an attack. It can give the impression that you are more intelligent by bringing psychology and metacognition into the conversation. #physiotalk
Dale Whelehan @Daleyfurter
@physiotalk 4. Promote culture of learning from error.Our colleagues in pharmacy are brilliant at this, and ultimately have personal/organisational barriers preventing error-making in this regard. Medicine, AHP and nursing alike should look at pharmacy as a framework for practice #physiotalk
Janet Thomas @JanetThomas47
@J0Physio @physiotalk We had a great post placement sessions at @QMUPhysio using case discussions in a fishbowl discussion to allow all to participate #physiotalk
Sibyl Edward, D.P.T. @pasl_pt
CDM is the backbone of a PT program. One should try actual reflections using examples ie providing the student the opportunity to examine how they make decision versus the theoretical concepts. #physiotalk
physiotalk @physiotalk
#physiotalk
Dale Whelehan @Daleyfurter
@zachwalston @physio_back @physiotalk Only one way to go when you're at the top 😉 #physiotalk
Ian Tyrrell @IanTyrrell5
@_lewadam @physiotalk Have seen this quite a lot! And with the experience of working in a few trusts across the country it happens! I always say to students, I’ll teach you what I do, but you have to adapt to what your educators do! Maybe I’m just a bit rogue! #physiotalk
ThePhysioBack @physio_back
RT @Daleyfurter: @physiotalk 4. Promote culture of learning from error.Our colleagues in pharmacy are brilliant at this, and ultimately hav…
Darragh Maguire @PhysioDarragh
@zachwalston @physiotalk @physio_back @Daleyfurter "Thinking Fast and Slow" by Kahneman is an excellent book to further explore bias and heuristics. Well worth a read. #physiotalk
Zachary Walston @zachwalston
@physiotalk Without doubt and uncertainty, we stop asking questions. Heuristics are valuable tools, but they need to be constantly updated and we need to recognize the potential for errors. (system 1 vs. system 2 thinking). #physiotalk
Nikita Mascarenhas @physioNikitaM
RT @physiotalk: #physiotalk
Janet Thomas @JanetThomas47
@zachwalston @IanTyrrell5 @physiotalk Don't bring metacognition into it :) #physiotalk https://t.co/7DYnYwyxqf
Saffron @SaffThePhysio
@zachwalston @physiotalk Perhaps requesting to run an in-service training session on alternative treatments/therapies could be a solution (improve CPD, presentation skills, and may help introduce new ideas to the team/change thinking patterns?) #physiotalk
Zachary Walston @zachwalston
@PhysioDarragh @physiotalk @physio_back @Daleyfurter It is the most influential book I have every read. I cannot recommend it enough. Another great one is How not to be wrong: the power of mathematical thinking. Superforcasting, how doctors think, your medical mind,and antifragile have influenced my practice too #physiotalk
physiotalk @physiotalk
RT @pasl_pt: CDM is the backbone of a PT program. One should try actual reflections using examples ie providing the student the opportunity…
Lewis Lovegrove @_lewadam
@IanTyrrell5 @physiotalk Love it. Effectively, take what you will from me but at the end of the day you're going to be the clinician. Blend and merge snippets from everyone you work with! #physiotalk
Nikita Mascarenhas @physioNikitaM
@physiotalk Active strategies work better than antyhing else, accepting pain is the best solution for persistent pain #physiotalk
physiotalk @physiotalk
Final question #physiotalk Q5: What are some heuristics that are beneficial in a clinical setting?
Zachary Walston @zachwalston
@S0uthernUpN0rth @physiotalk I think that can absolutely help. A primary challenge is the frequency of education. A single in-service or lecture is just the start. This needs to be a continuous conversation and the foundation of learning and applying information in clinical practice. #physiotalk
Dale Whelehan @Daleyfurter
@zachwalston @PhysioDarragh @physiotalk @physio_back 'The power of habit' also great to explain behaviours and 'nudge' to identify means of changing behaviours though personal and environmental engineering! #physiotalk
Zachary Walston @zachwalston
@_lewadam @IanTyrrell5 @physiotalk Absolutely. There is so much value to be gained by learning from the perspectives of others. #physiotalk
Janet Thomas @JanetThomas47
@physiotalk There is always trial and error! #physiotalk
Zachary Walston @zachwalston
@physiotalk Mental short-cuts in general allow us to more rapidly assess clinical situations. The key is taking the time to activate system two and reflect when able. Additionally, practicing recognizing biases can help us navigate cognitive traps more effectively. #physiotalk
Sibyl Edward, D.P.T. @pasl_pt
@physiotalk Q5. Fast frugal where one can use classifications. #physiotalk.
Dale Whelehan @Daleyfurter
@physiotalk Coming in with a list: Anchoring - An effective heuristic for ensuring efficiency and targeted assessment and treatment Availability - Relying on availability is often helpful during reasoning because things that come to mind easily generally do occur more frequently. #physiotalk
Nikita Mascarenhas @physioNikitaM
@physiotalk From Manchester #physiotalk
Dale Whelehan @Daleyfurter
@physiotalk Confirmation: assists experienced practitioners in resource-scare environments to make rapid low-risk decisions Representativeness: for experienced practitioners, pattern recognition is valuable to assist in delivery of prompt treatment #physiotalk
Ian Tyrrell @IanTyrrell5
@_lewadam @physiotalk Well let’s be honest a defence of I do it because I learnt it from senior x isn’t defensible in a court of law! We are autonomous practitioners and have to make our own minds up! I share my thoughts and thinking, up to you if you want to make the decisions I do! #physiotalk
physiotalk @physiotalk
#physiotalk
Lewis Lovegrove @_lewadam
@IanTyrrell5 @physiotalk Can't argue with that! 😉 #physiotalk
Dale Whelehan @Daleyfurter
@physiotalk Commission: take risks in settings of uncertainty where the outcome may ultimately benefit the patient Bandwagon: cooperation is improved in this instance, resulting in greater team harmony and less occupational stress (in the short term) #physiotalk
Dale Whelehan @Daleyfurter
@physiotalk Overconfidence: advantageous to practitioner as it increases ambition and persistence in difficult situations Aggregate: This may be appropriate when experienced research practitioners identify limitations in current guidelines #physiotalk
Zachary Walston @zachwalston
@IanTyrrell5 @_lewadam @physiotalk The perspectives can also provide the "art" portion of the art-science balancing act that is treatment. Trials and basic science provide a foundation for treatment efficacy, but experience, perspective, values, etc. allow us to develop tailored, patient-centric care #physiotalk
physiotalk @physiotalk
Great list! Thanks #physiotalk
Zachary Walston @zachwalston
#physiotalk @Daleyfurter came prepared!
Sibyl Edward, D.P.T. @pasl_pt
@zachwalston @Daleyfurter So true. Lots to learn. Thanks @Daleyfurter #physiotalk
ThePhysioBack @physio_back
@zachwalston @Daleyfurter Absolutely. Been great to learn from his and your knowledge. Fascinating subject. #physiotalk
Zachary Walston @zachwalston
@Daleyfurter @physiotalk Let me know when it is published. It will jump to the top of the stack. #physiotalk
physiotalk @physiotalk
That concludes tonight’s chat. Thank you for your involvement! Keep chatting using the #physiotalk hashtag. The chat transcript will be posted shortly.
Dale Whelehan @Daleyfurter
@zachwalston Thank you - you might see it in a published paper on the topic in physiotherapy in the near future 😉#physiotalk #underpeerreview @physiotalk
Dale Whelehan @Daleyfurter
@zachwalston @physiotalk it'd be great to get some collaboration going in the field Dr. Walston - important research you're doing! #physiotalk
Zachary Walston @zachwalston
@physio_back @Daleyfurter Thank you @physio_back. I agree, I feel fortunate to have had @Daleyfurter on the #physiotalk. This hour flew by and I enjoyed it.
ThePhysioBack @physio_back
RT @zachwalston: @IanTyrrell5 @_lewadam @physiotalk The perspectives can also provide the "art" portion of the art-science balancing act th…
Janet Thomas @JanetThomas47
@physiotalk Fascinating topic tonight. One to really broaden your thinking and examine your own biases. Thank you @zachwalston #physiotalk
Zachary Walston @zachwalston
@Daleyfurter @physiotalk I completely agree. Let's find time to connect. It is great to see the contributions you have made in this area. #physiotalk
Zachary Walston @zachwalston
@JanetThomas47 @physiotalk Thank you @JanetThomas47 for the feedback and thank you @physiotalk for the opportunity. This was a great discussion and I am thrilled to see so many people interested in it. #physiotalk
ThePhysioBack @physio_back
RT @Daleyfurter: @physio_back @zachwalston @physiotalk Of course other variables at play here such as Dunning-Kruger effect with regards to…
physiotalk @physiotalk
Our next #physiotalk is coming up in two weeks time on Physiotherapy experiences with patients of ethnic minorities with @painincommunity https://t.co/iOwhLjkQnZ
physiotalk @physiotalk
@zachwalston @JanetThomas47 Thank YOU for suggesting the topic. Remember that we are always looking for people to suggest themes and topics for our chats - just tweet or DM us! #physiotalk
Darragh Maguire @PhysioDarragh
@Daleyfurter @physiotalk Is the availability heuristic as applied to physio: 'You can't diagnose something you know nothing about'? Ie. If you're not aware of, for example Inflammatory Disease as a potential cause of back pain, you fail to screen for it, fail to diagnose it. #physiotalk
CambsPboroAHPs @CambsPboroAHPs
RT @physiotalk: Our next #physiotalk is coming up in two weeks time on Physiotherapy experiences with patients of ethnic minorities with @p
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