Inquisitiveness can lead one into dangerous situations
Whilst curiosity is not in truth a cognitive bias, I though it worth considering as part of these series of blogs exploring clinical reasoning and cognitive biases. Curiosity is an essential trait in medical practitioners and health professionals more broadly. Dyche and Epstein (2011) discuss the importance of curiosity to develop rapport, support clinical reasoning, and provide contextual and patient-centred care. They report that curiosity can help to avoid premature closure and encourages lifelong learning. Some recent trends in medicine and medical education however can suppress this curiosity by encouraging proforma approaches and passive learning. Fitzgerald (1999) discusses the significant contribution of curiosity to advances in medicine which should not be underestimated.
But, curiosity requires moderation and should be applied appropriately when generating a hypothesis and seeking further investigation.
“Curiosity killed the cat” as the proverb states actually originated as ‘care killed the cat’ in a 1598 play script. What was meant by care was ‘worry/sorrow’ or to consider more broadly, affective influence. It was proposed that despite cats having nine lives, ‘care’ could wear them all out. We all know that the ‘cat life’ is a metaphor for chance, but as humans, we do have greater opportunity for rational decision-making, especially in decisions relating to medical care, rather than relying on just chance. We can look at this proverb from several perspectives as GPs:
- What if we allow our emotions/care (i.e. gut feel) to influence our clinical decision making?
Perhaps we might fail to consider an important alternative diagnosis and not explore the ‘checks and balances‘ required to make sure that we are not missing something.
- What if we allow our curiosity to inform low-value investigations that may cause the patient psychological distress, physical risk or additional cost?
I’m sure we can all think of a case where we found an ‘incidentaloma’, the diagnosis of which caused the patient undue distress (and perhaps led to further unnecessary investigations). Inappropriate ordering of investigations is also closely linked with low risk tolerance where a practitioner attempts to use investigations to mitigate against a missed diagnosis.
So how do we, as medical practitioners, achieve ‘balance’ in our curiosity to ensure appropriate patient outcomes? The answer again is in metacognition – ‘thinking about our thinking’. When being ‘curious’ about a patient and their clinical condition, we should consider how this curiosity is affecting our clinical decision-making particularly with regards to being over-zealous in our investigations, or making a treatment plan that differs significantly from recommended practice due to emotional influences.
For those doctors sitting the Key Features Paper (i.e. clinical reasoning exam) in two weeks time, consider how your curiosity affects your practice, and how this might apply to how you approach clinical scenarios in the KFP. Consider particular cases in your practice where curiosity got the better of you to produce an inefficient outcome. By doing this, you may recognise situations or clinical areas that you are more likely to answer incorrectly in the exam (and of course in your clinical practice). When considering investigations, choose those that are going to confirm or exclude your diagnosis, or assist in your management. Each investigation should link back to a differential you have already considered. Investigations should not be used as a ‘sieve’ to catch a diagnosis you haven’t thought of. Use your curiosity to ensure that you explore the less likely diagnoses as least as much as the likely diagnoses but don’t go to over the top trying to find the zebras!
Dyche, L., & Epstein, R. (2011). Curiosity and medical education (Vol. 45).
Fitzgerald, F. (1999). On being a Doctor. Annals of Internal Medicine, 130(1), 70-72.
Martin, G. (2017). The Phrase Finder. Retrieved from https://www.phrases.org.uk/meanings/curiosity-killed-the-cat.html, Accessed on 21st January, 2018