When experience doesn’t help learning #WILTW

This is the 150th #WILTW

Grace Hopper apparently was behind the quote:

..the most dangerous phrase in the language is, “We’ve always done it this way”

It’s usually used to describe the persistence of organisational blindness to repeated but ineffecient processes. However there are individual practices, especially in medicine, that despite evidence to contrary persist throughout a clinicians whole career. Some of this is pure bloody mindedness, and some ignorance, but a small proportion is related to personal experience, often a result of being burnt.

I’m generally not an over-cautious doctor but children I see with a history of abdominal trauma definitely get over-observed. I can’t help it. I am completely aware of the cognitive bias my experience with a single patient has placed in my diagnostic armoury but its difficult to shake. While I have always tried to explain this to students and juniors I can’t be sure I always do so.

It is only now I understand some of the odd habits of senior doctors who have taught me in the past. These probably weren’t eccentric foibles but more likely the product of the one instance, in a very specific but probably un-reproducible case,  when a sign was missed or an investigation not ordered which unfortunately had a bad outcome. The learning for the individual obvious and profound. But perhaps this context may have been lost on all the doctors subsequently taught by them…

What have you learnt this week? #WILTW

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