Instead of reading, you could also just listen …
The curse of knowledge is, that you don’t know what they don’t know.
When you know something, it is difficult to see the world without that knowledge.
In the first post of this blog, I highlighted the different ways we all see the world.
We use “perception filters” to make sense in a complicated world and to orientate ourselves quickly.
There is also another aspect to this filtering that I have not yet highlighted: the curse of knowledge.
Surprising results of an intriguing study
When you know something, it is difficult to see the world without that knowledge.
In her dissertation “The rocky road from actions to intentions” Elizabeth L. Newton highlights this struggle in the following experiment:
80 Stanford undergraduates (48 male and 32 female) were recruited in pairs. One of the participants got the role of the “tapper” and the other became the “listener”.
“Tappers” got a list of 25 well-known songs and were asked to tap out three songs from that list. They were also asked about the probability for the listeners to identify the song, as well as for an imaginary audience of 100 listeners to perform the same identification.
“Listeners” learned that they needed to guess what song the tappers were tapping. They were asked to write down their guess after every tune.
Both were told not to communicate for the duration of the three songs tapped.
After all three songs had been tapped, the “tappers” were asked to name their first song.
Now the experimenter then told both the “tapper” and the “listener” that she would be tapping out this tune and that they both now needed to estimate how many listeners would guess the song correctly.
The result: “tappers” significantly overestimated the accuracy for the correct answer with their estimate reaching from 8 – 95% while only 2.5% of the answers were correct.
Why do they get it so wrong?
Where does this misjudgement originate from?
When we think about a song and tap it out, we imagine the song with the whole melody and rhythm.
For the recipient of the tapping only the rhythm is present, and by itself this is too little information to go on to identify the song.
The curse of knowledge:
The curse of knowledge is, that you don’t know what they don’t know.
As we know the song, we cannot “un-hear” it.
The curse of knowledge in medical environment
We know, they don’t.
The curse of knowledge is, that you don’t know what they don’t know.
This is the big obstacle.
Frequently, when we provide medical information, we are aware of the concepts and mechanisms and interactions of different organ systems.
We miss out the aspect, that the paediatric patient and their parents are missing this background of knowledge.
What might be
a blank paper with some dots for our patients is an intricate, complex structure for us.
The curse of knowledge is, that you don’t know what they don’t know.
Tap out the song
We tap the song, without considering, that they do not “hear” the melody. This lack of adjustment to the way, how we present information, frequently leads to misunderstanding and frustrations on both sides.
The curse of knowledge is, that you don’t know what they don’t know.
Our socialisation inside the medical circle makes it almost impossible to attune our language to someone, who does not “speak” our language.
Recently, I have been involved in developing patient-information material.
The colleagues insisted on using the word “endoscope”, while I tried to substitute this with the word “tube”. For medical ears, the word “tube” sounds too basic. For us, an endoscope is an immediately understandable concept. We see it in front of our mental eyes. We understand it.
I doubt that all of our paediatric patients would have the same mental image present.
To use the word “tube” instead would provide them with a concept they know, as described in a previous post (about complexity).
The default mode of dealing with knowledge imbalance
We tend to fill the imbalance of knowledge and understanding with doctors authority.
Our patients know that they do not know everything.
They lean on our understanding and guidance.
We hope that they follow the doctor’s order because we told them to.
It also provides us with some status and that feels quite nice.
Unfortunately, our impression on the child and their parent’s that lasts only some time.
The long-term effect of medical belief systems
In a previous post, I have written about the patient’s own concept of their situation.
Even if you, as a doctor, would invest 30 min of your time, to repeating telling the patient, what they need to do, you will lose in the long term.
Why?
If they have not understood the concept of the problem, they cannot grasp their role in the treatment.
If they do not grasp the concept, that they are an active partner in the treatment process, they will expect that you “heal them”, while they remain passive.
Even if they understand that they have to “play their part”, they might feel overwhelmed and discouraged by the bit that they need to contribute.
One typical example to illustrate this issue are patients, from whom we demand, that they lose weight.
In the end, the paediatric patient and their parents will deal with the situation according to their understanding!
Their inner voice whispers in their ears for hours on end, and we just had about 30 minutes to challenge their preset concepts.
As we struggle to see the world from their standpoint, consequently we struggle to provide them with the input they need in a way that they can take advantage of that information.
In a nutshell:
The curse of knowledge is, that you don’t know what they don’t know.
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