Lastly, there are societal and internal pressures that feed into an unrealistic visage that physicians cannot make mistakes. As a result, we may internalize and overestimate our professional competency. On top of that, it is just naturally difficult to admit or confront one’s own mistakes. Sometimes it feels better to feel right than to be right. These pressures create obstacles for one to self-evaluate their performance critically and accurately.
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ACEP Now: Vol 42 – No 02 – February 2023Strategies for Combating Overconfidence
1. Identify knowledge gaps and create a plan to fill these gaps.
Recognize that the practice of medicine has limitations. Even with the latest evidence and training, there will always be a level of uncertainty. One established practice pattern today may be altered or completely refuted in a few years. Be open to the possibility of change.
Honestly evaluate yourself. Make a list and be specific. Look at your strengths. If electrocardiogram interpretations are a strength, why do you believe it is a strength? What strategies have you employed to create it as a strength? Are there any uncertainties to resolve? Then, look at what may be needed to make an area of improvement into a strength. If point-of-care echocardiograms are a weakness, be specific. Is it looking for right heart strain or looking for regional wall motion abnormalities? Then, create a plan of action to improve these areas—do a review of literature, watch videos, take a course, practice with simulation, and implement into your real-time practice.8
2. Frame your professional identity and motivations.
Framing a growth mindset to emphasize pride in effort rather than pride in skill or status can combat pitfalls of overconfidence. To say, “I value the courage to admit mistakes, continual learning, and the effort to improve” over “I value my accolades, accomplishments, and titles” can be a powerful shift.9
3. Implement cognitive pauses.
“Cognitive pauses” are deliberate interruptions in your workflow to apply critical thinking or reevaluate available data. In medicine, cognitive pauses can be used to critically assess available lab results, imaging, challenge one’s own final diagnosis, and/or reaffirm the possibility of overconfidence. What results do not fit with my diagnosis? Are there alternative diagnoses I have not considered? Cognitive pauses can be applied in a nondiscriminatory or in a situation-dependent fashion. For example, a “blanket” cognitive pause can be applied prior to every patient discharge or situation-dependent one when encountering an unfamiliar or very complex case.
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2 Responses to “Why Physicians Are Overconfident and How We Can Overcome It”
March 5, 2023
tom benzoniDr. Koo
Thank you for a concise and thoughtful essay. It is a needed check. I especially like the cognitive pause, to ask WECIB (What Else Could It Be?)
I am entering my 5th decade in EM; I would be interested in thoughts on the flip side. Once you/I have seen a lot of cases and, yes, caused a lot of harm, we’re less certain.
For example, some EPs are confident in TPA for stroke, not aware they are observing the natural history of many strokes as well as seeing stroke mimics. That confidence takes a hit when they injure a patient with a bleed that would not have otherwise occurred. Confidence weakens further when, with followup (rare now that we use EBRs (Electronic Billing Records) that have to be closed by end of shift), we discover the patient had a stroke mimic and could not possibly benefit from our therapy but they could/did for sure suffer harm.
Thus a thought: enjoy the over-confidence. It is a luxury that, should you survive long enough in EM, will be regarded in the rear-view mirror with fond indulgence.
July 17, 2024
Alex KooDr. Benzoni,
Thank you for a really insightful perspective and realized this is a late comment to your post, so apologies. Honestly, I didn’t know comments were even a thing for the ACEP Now articles so thank you for it!
“Enjoy the overconfidence” is a great pearl and I’ve taken that one to heart. I’ve interpreted your wise line as a reminder to reflect earnestly – non-critically and non-judgmentally.
The “overconfidence” in certain scenarios will be inevitable, particularly with nuanced or novel cases when there are unseen potholes. And to your point, I could see residency as a safer environment for understanding overconfidence and learning from cognitive errors. The resident is allotted this luxury under supervision and honestly, it can be argued that only through “pushing the envelope” of one’s abilities can one learn. Feigning confidence is sometimes the necessary impetus to say, “this angioedema patient needs a cricothyrotomy” before it’s too late. “Analysis paralysis” will always be the flip side of overconfidence and can be to the patient’s detriment.
I really appreciate your wisdom and thoughtful insight – I would look fondly on an earlier self and sometimes, see a reflection of the same in the residents we have the opportunity to work with!