Over the weekend, I finished a quilt I had started last year. The quilt had been meant for a friend’s baby who was stillborn shortly before I completed it. I have become superstitious about quilts because, in the past five years, I have started several quilts with specific people in mind only to have that individual pass away before the quilt could be completed. This magical thinking is related only to larger sized quilts, I’ve noticed, although what I ought to consider is that deaths are not related to my quilts at all. This connection is not magic but confirmation bias.

I understand a fair amount about confirmation bias. I’ve read about it, I realize that I should pay more attention to real data and science than to the untested theories I have, based on “my years of clinical experience”. The problem is that magic seems more powerful and the evidence is that half the people agree with me. Actually, whenever I raise the topic of superstitions at dinner or in casual conversations, it would be my impression that many more people than half the population are superstitious – but that’s my impression, not based on any real data and, despite my interest in the scientific method, I don’t think I’ll start handing out short questionnaires at dinner parties or clinical rounds to test my hypothesis.

This is a great video by Stuart Vyse on superstitions:

Superstitions, despite how common they are, have not been extensively studied per se, although confirmation bias, which is linked to superstition, can be understood by anyone through the work of Tom Nichols, Daniel Kahneman and Amos Tversky. There have been several studies of that highly superstitious group of people: sports fans. Kent State Researcher, Shana Wilson, and Murray State University’s Daniel Wann have both studied this group. Since both the Stanley Cup play-offs and the NBA play-offs are currently running, I am certain everyone can think of at least one acquaintance with play-off related superstitions. Researchers confirm that sports fans – and likely all superstitious people – are reacting to their anxiety by trying to control it. Since this is impossible, the rituals or theories that they have are the means to “control” the outcome.

In the same way, in our daily lives, many of us have similar rituals to sports fans that we may employ when we are facing uncertainty. Having read Nichols, Kahneman and Tversky, I am pretty good at not falling into this trap in my clinical practice. I do not have special clothes that I wear when I’m trying to work out a difficult clinical issue or treatment plan – although I do when I’m making a presentation. To be completely honest, I also have one specific colleague whom I consult with respect to diagnostic dilemmas and whom I believe will always be able to provide insight – but I’m hoping that has not become a superstitious ritual. The fact is that I am highly anxious, although I hope I don’t resort to magic (other than serial consultation rituals) to have my clinical work go smoothly and my patients do well.

I believe that well-educated humans who rely on science and evidence can have magical thinking and be superstitious because magic and science have, as American Natural Scientist Loren Eiseley observed, the same roots:

“…what works may work again.
This is the root of magic
and science,
life’s response to
uncertainties-
If a thing works
you try it
and try once more
and again
until
you are absolutely sure
it will never work,
then try it once more.”
(from Magic by Loren Eiseley)

There is something magical about science, and medicine does not escape from that impression, no matter how much doctors hold on to science. Like me, many doctors also cope with the heartbreaking science of the most intractable illnesses by clinging as well to the deeply subjective elements of their profession, such as “years of clinical experience”. In those deeply subjective elements, magic can thrive. If I can remember this, I will fearlessly construct new quilts, although in the life and death matters of patient care, which can be more anxiety-provoking, I fear the magic may be too tempting.

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