Clinical Reasoning in MSK Management

- Intuitive

- Inductive

- Fast

- Shaped by experience

- Very efficient but prone to error and bias.

what are the key points of system 1 of Dual Process Theory

- Slow

- Deliberate

- Systematic

- Deductive

what are the key points of system 2 of Dual Process Theory

Pattern Recognition

Dual Process Theory System 1

• Direct automatic retrieval of information from a well-structured knowledge base dependent on prior exposure to similar cases.

Hypothetico-deductive reasoning

Dual Process Theory System 2

• Involves the generation of hypotheses based on clinical data and knowledge, and testing of these hypotheses through further inquiry.

confirmation bias

Tendency to look for, notice, and remember information that fits with our pre-existing expectations. 

outcome bias

- Tendency to overestimate effects of reasoning process and favored treatments after positive outcome.

- Tendency to place a lesser value on reasoning process after negative outcomes.

- Encourage focusing on the process of clinical decision making rather than outcome to overcome this bias.

- “The patient got better so my treatment worked.”

- The patient may have gotten better anyway

what are examples of a tendency to overestimate effects of reasoning process and favored treatments after positive outcome seen in outcome bias

Mechanical-postural-structural bias

Deviations from so called normal posture or structural alignment are the cause of pain.

- scoliosis

- leg length discrepancy

- forward head posture

- scapular winging

- foot pronation.

what are examples of conditions that may lead to Mechanical-postural-structural bias

Dunning–Kruger effect 

a cognitive bias in which low-ability individuals suffer from illusory superiority, mistakenly assessing their ability as much higher than it really is.