Conspiracy theories and clinical decision making

Conspiracy theories are big news at the moment, be it QAnon, 5G, vaccines or whatever else is floating around. When you’re a non-believer its pretty hard to understand how someone can hold this position. But as health care professionals, we might have more in common with them than we think. Because the foundation of all conspiracy theories is the same as clinical decision making - abductive reasoning.

Abductive reasoning a process of thinking that develops an explanation based on observations. It’s what Sherlock Holmes does and if you’re a clinician, it’s what you do too. You observe something, like a collection of clinical signs and symptoms or a type of behaviour. You determine a collection of possible explanations for these observations and then gradually rule them out until you arrive at the most plausible one.

The same basic process of thought lies behind conspiracy theories. What separates the two (we hope!) is that clinical decision making observes the good practices of abductive reasoning.

The video below provides a solid (albeit a wee bit long) explanation of this, using the example of the Beatles and the so-called death of Paul McCartney. (Dr Gerben Moerman from University of Amsterdam provides a series of lectures on qualitative research methods available on YouTube which I highly recommend for anyone interested in research).

What this means for engaging conspiracy theorists in meaningful conversations, I have no idea. But what it means for those of us who use abductive reasoning in our professional work, be it clinical decision making or conduct of research, is that we need to be conscious of these potential pitfalls to ensure we don’t replicate them!

So what are some of things we should be aware of to make sure we’re not like the conspiracy theory types?

Always remember that abductive reasoning is being used to develop a best possible explanation (i.e. a guess). It may be a very well informed guess, but unless that guess is assessed further (i.e. through the use of inductive and deductive reasoning to assess the evidence and test the hypothesis) it cannot be presented as fact. So remain open to the possibility that other explanations exist.

Recognise that the strength of your explanation depends on the quality of the information you’re using. This means that you have to seek out information that could disprove your explanation, don’t cherry pick the bits that confirms your proposed explanation. And don’t rush to conclusions before considering all the information at hand. Make an effort to ensure you have the most complete and accurate information possible. (This is one of the reasons building a trusting therapeutic relationship is so important, because patients are a key source of information (see The essential ingredient of a trusting therapeutic relationship)).

Finally, understand that abductive reasoning is a creative thought process, not a matter of blindly following a procedure. It is a professional skill that needs to be actively developed, just like your therapeutic knowledge. Part of this skill is having the humility to accept that you have blind spots. Whether you are early in your practice (see The Beginner’s Gap) or not, the reality of contemporary medicine is that there is no clinician on the planet that doesn’t have a blind spot. So expect blind spots to be there and put processes in place to mange them. Engage with peers and colleagues. Gain a different perspective on the problem and be open to the idea that your best possible explanation is not necessarily the best one.