In our journey over the last several articles about methodology for decision making, I have discussed my colleague, who asked for advice about whether or not she should close her practice and become an employed hospital physician. I shared with you my overzealousness to provide an answer, even though I lacked any sort of formal or systematic decision-making process.
I also discussed the WRAP framework written about in “Decisive” by Chip and Dan Heath–a 4-step process that you can employ to help make better decisions consistently. By applying a process where we normally fail to do so, we can consider options we might have otherwise overlooked or information we might have otherwise ignored. In the last post we focused on widening our options and avoiding narrow framing when we make decisions. The second step of the WRAP framework is to reality test your assumptions.
Find Disconfirming Evidence To Avoid Confirmation Bias
In the second article of this series we identified confirmation bias as one of the villains of decision making. While my colleague thought that using a pros-and-cons list was a good tool to help her make a systematic decision, confirmation bias points out our tendency to want to follow our guts. I often refer to this with trainees as the “grass always appears greener, but rarely ever is” syndrome. My colleague is unhappy, but is she trading one set of problems for a new and different set of problems that will leave her still unhappy in 6 months?
Confirmation bias tells us that we tend to seek out information that supports the quick belief we developed, in this case the very green-looking grass of the new job. The idea is that we really want reassurance about our decision, rather than the truth. Human nature leads us to spotlight what we want to be true and seek out information that supports our gut. We then think we have made a thoughtful, scientific, reasoned decision, when we really have not.
The question becomes: is there a set of questions or experiences that might allow us to overcome confirmation bias?
Questions and Experiences That Identify Disconfirming Evidence
Before giving up her successful practice, what might my colleague do to identify whether she is making a good decision or just grazing through the green grass? First, she could “ooch.” Rather then sell her practice and dive right in, she might choose to wait six months and work several weekend shifts or even take two weeks off and work full time for a short period. Why wonder if you will like being an employed physician when you can go out and see what it is really like? This is a real world experiment and experience that will be better than any analysis you could do. It allows you to dip your toes into the waters of being an employed physician without diving in headfirst.
Another strategy for my colleague would be to assume that this will turn out to be a really bad decision and go looking for evidence or proof to support the idea that becoming an employed physician is a bad decision for her. By directly looking for disconfirming information, you are less likely to be impacted by confirmation bias. Strategies for this might include taking a colleague who has transitioned to employed practice out to lunch and asking questions like:
- What problems were you experiencing that led you to an employed practice?
- How did you think being an employed physician would improve those problems?
- Were your problems improved by making the switch?
- What additional problems did you encounter?
You might also look around for someone in your community who transitioned to an employed practice and then decided it was not for them. Find this person and find out what happened, so you do not make the same mistakes. If you are not able to find someone locally then go online to a physician job board or career site and you will likely find someone there. Ask a spouse, significant other, or colleague to directly take a disconfirming point of view.
Additionally, asking probing questions of your potential employer can bring disconfirming evidence to light. I suggest asking any potential employer at least the following about their physician turnover:
- How many physicians have you hired in the last five years?
- How many physicians remain in this practice group?
- Can I speak with the last two physicians who left?
Frequent turnover means something is likely wrong, whether you can identify it or not. Not letting you speak with the last physicians leaving the practice is a big red flag, indicating possible problems that your potential employer does not want you to discuss with someone who just left.
Next time you need to make an important decision, ask yourself where you might get disconfirming information so that you do not become a victim of confirmation bias. Consider plans that gather direct experience to help you overcome it, or ask an expert that can give you the benefit of their experience. In the next article we will see how attaining distance from your decision actually improves your decision-making ability.