2 Responses to “Why Physicians Are Overconfident and How We Can Overcome It”

1. 

   March 5, 2023

   tom benzoni Reply

   Dr. 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 Koo Reply

     Dr. 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!