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Avoid the Therapeutic Illusion
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Here’s a quick one for you. This issue of Practice Perfect brings you the warning to avoid the therapeutic illusion.1
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What is the therapeutic illusion, you ask? That’s a good question, because it affects all of us that practice patient care. This is defined as “the unjustified enthusiasm for treatment on the part of both patients and doctors”.2 Basically, this is an error that physicians make when they think their treatment is more effective than it really is.
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An Example of the Therapeutic Illusion
Let’s take a purely hypothetical clinical situation. Say I am treating a patient with heel pain that I have diagnosed as plantar fasciitis. When I started treating this patient, I prescribed relative rest and ibuprofen. For some reason, I did not prescribe any other treatment. (I know, of course I prescribed other treatment, but let’s keep this simple for the sake of our conversation.) One month later, the patient returns stating she is feeling much better. As a result, I think that the rest and ibuprofen were responsible for her cure. However, the patient failed to tell me that she lost 10 pounds in the last month as a result of starting swimming exercise. The treatment success was not because of my treatment, but rather her weight loss. But since I do not know this, I begin treating all my heel pain patients with nothing but rest and ibuprofen. Clearly this is not going to make for good outcomes.
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This example, though hypothetical in nature, is unfortunately too common in medicine and potentially has a large effect on our patients. For example, if a surgeon performs a particular procedure, and that procedure seems to work in a patient, but the success was actually due to random chance, then other patients could be hurt in the future.
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This therapeutic illusion is thought to occur due to a couple of reasons
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Confirmation bias – This form of thought error occurs when we selectively look for evidence that supports what we think is true.
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Heuristics – These are rules of thumb that we often subconsciously rely on to make decisions. If an incorrect heuristic is created, then it will be reinforced.
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How to Avoid the Therapeutic Illusion
So, how do we prevent ourselves from making this error?
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Be a skeptic - Always question your outcomes, especially if they seem too good to be true. Is there another reason your patient had that outcome? Could random chance have been a participant? Is there some bias that caused that supposedly successful research study to have a different result?
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Use conscious heuristics instead of the unconscious ones - For example, we are all taught in medicine the phrase “when you hear hoof beats, think of horses not zebras.” This is the error that many of my students make when they encounter something a little out of the ordinary, such as a common diagnosis with an uncommon presentation.
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If we all adhere to some simple logical rules our patients will be better off for it. Avoid the therapeutic illusion at all costs!
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