Reasoning Errors, Assumptions and Reducing Noise in Physiotherapy

Many of the 30 cognitive errors Croskerry describes come from fast reasoning on too little information. Mark covers priming by referrals and imaging, confirmation bias, ascertainment bias from stereotyping, lack of thoroughness, excessive coherence, poor synthesis and weighting, and failure to monitor outcomes. Common assumptions include that pathology is never relevant, that every impairment must be treated, that distress always contributes and that patients who skip exercises are unmotivated. The remedies are to clarify and qualify what patients say, screen for other symptoms and aggravating factors, test competing hypotheses, attend to findings that do not fit and seek second opinions. Self-reflection worksheets and staged case studies help build skill. From Kahneman's work, he proposes a physiotherapy noise audit, with clinicians judging the same cases independently, and decision hygiene: structured examinations, an explicit reasoning framework, sub-judgments, agreed criteria, guidelines, bias training, delayed intuition and intellectual humility. One medical study found skill explained 44% of variation in diagnostic decisions.