Dental psychology

four stages of competence

Dental psychology that I like

Dental psychology or really just psychology that I find that interests me personally.

Dunning–Kruger effect

Dunning-Kruger is a failure of metacognition, the ability to gauge what you know and what you don’t know. Although the Dunning–Kruger effect was formulated in 1999, Dunning and Kruger have noted earlier observations along similar lines by philosophers and scientists, including Confucius (“Real knowledge is to know the extent of one’s ignorance”),[2] Bertrand Russell (“One of the painful things about our time is that those who feel certainty are stupid, and those with any imagination and understanding are filled with doubt and indecision”),[10] and Charles Darwin, whom they quoted in their original paper (“Ignorance more frequently begets confidence than does knowledge”). The story about how Dunning Kruger first started thinking about the subject is interesting. It began with a man who thought that because lemon juice could be used to write hidden messages, he also thought it would hide his face from cameras.

Image of dunning kruger effect

Four stages of competence

The four stages of competence leaning process. Thsi one ties in with the Dunning-Kruger effect.

Four stages of competence

 

Image of the four stages of competence from dental psychology blog

Pygmalion effect and the Golem effect

The jist of both of these is that people tend to live up or down to the expectations people put on them.

Drama Triangle

A conflict triangle of human interaction. Often the government and social organizations with good short term intentions end up playing the rescuer, thus creating a sub-culture of victims.

Drama triangle

False memories

Brain hack by Julia Shaw.  Elizabeth Loftus is an expert on the topic and it is interesting to read the probably expected push back she got on the topic. People definitely do not want to believe their memory is anything except infallible. It’s my opinion the more erratic and less historically accurate individuals are far less prone to accept that their memory could be inaccurate. Overly emotional people are much more likely to make something up and believe it, which is dangerous.

Hawthorne effect

Another one of my all time favorites is the Hawthorne effect or the observer effect.

Hope experiment – The power of hope is shown in the 7 triggers of yes to have some of the highest fMRI brain responses. The hope experiment is showing the same results.

Bash Trap

When people are caught in a bash trap they compulsively continue to bash themselves against the same situation. This is from Born to Win.

Human need to worship something

Humans seem to have a need to worship something they feel is greater than themselves that is all powerful and can fix problems. Too often it becomes people or the government or ruling party. I like Russell Brand’s thoughts on it.

Obedience

Stanley Milgram is famous for his experiences in this field. He found that 80% of the population does not have the physiological or moral resources to defy an authority’s order, no matter have illegitimate the order is.

Critical impact of fatherhood

Old study but many others show this as well. Bronfenbrenner found boys without fathers lack ambition, seek immediate gratification, feel not-OK, are followers of their peer group, and revert to juvenile delinquency. How much is genetic and how much is nurture, since immediate gratification of the father is certainly a big part of how the child became fatherless.

Creep or Prevalence-induced concept change in human judgment

Has impact in continual push of everything, long after the problem has been eradicated or reduced. See in violence and racism, Jamie Fox, and most of societies ills. If you allow something to be condemned as wrong or improper those that complain about such things jut find something new, the goalposts move. I contend we see this in dentistry. As decay decreased in the American population dentists started seeing new problems that needing fixing; gum grafts, abstractions broadening the definition of decay and being more aggressive in diagnosis.

Diagnostic biases in dentistry

Baader-Meinhof Phenomenon or Frequency Illusion

Similar to creep in some sense, such as the Jamie Fox example. It refers to the false impression that something happens more frequently than it actually does. Often this occurs when we learn something new and then we seem to see that new thing more frequently. However, it’s really only our awareness of it that has increased. Another example is the scar experiment.

Brandolini’s law

Brandolini’s law says it takes an order of magnitude to counteract a false accusation. This is seen most often in trying to counteract a politician, a cult leader, a snake oil salesman, etc. Here is a list of many other similar https://twitter.com/g_s_bhogal/status/1438972527838117895?s=11

Behavioral economics

The study of humans predictably irrational behavior and actions against their own best interest. Deals with a lot of cognitive bias.

Cognitive bias – There are a lot of them.

Cool video on some of them.

Confirmation bias involves selectively gathering and interpretation evidence to conform with one’s beliefs, as well as neglecting evidence that contradicts them. There is a lot of these as seen in this visual map and this list. An example is refusing to consider alternative diagnoses once an initial diagnosis has been established, even though data, such as laboratory results, might contradict it.

“This bias leads physicians to see what they want to see,” the authors wrote. “Since it occurs early in the treatment pathway, confirmation bias can lead to mistaken diagnoses being passed on to and accepted by other clinicians without their validity being questioned, a process referred to as diagnostic momentum.”

 

Anchoring bias is much like confirmation bias and refers to the practice of prioritizing information and data that support one’s initial impressions of evidence, even when those impressions are incorrect. Imagine attributing a patient’s back pain to known osteoporosis without ruling out other potential causes.

Affect heuristic describes when a physician’s actions are swayed by emotional reactions instead of rational deliberation about risks and benefits. It is context or patient specific and can manifest when physician experiences positive or negative feelings toward a patient based on prior experiences.

Outcomes bias refers to the practice of believing that clinical results—good or bad—are always attributable to prior decisions, even if the physician has no valid reason to think this, preventing him from assimilating feedback to improve his performance.

Focusing fallacy is a term from A Nation of Wimps and seems to refer to the believe that because you focus and are interested in something others are as well. In the books case it was referring to children.

Baader–Meinhof phenomenon or frequency bias after noticing something for the first time, there is a tendency to notice it more often, leading someone to believe that it has a high frequency of occurrence.

Salient bias is selection of more emotional striking information. Present bias is opting for smaller reward now rather than larger reward later, opposite of delayed gratification. Planning fallacy refers to our tendency to over=estimate our ability to complete a task in a given time. Interesting article on using behavioral economics to get patients to keep their dental visit. Wang JADA 2020

Planning fallacy is a phenomenon in which predictions about how much time will be needed to complete a future task display an optimism bias and underestimate the time needed.

Red Herring fallacy – Attempting to redirect the argument to another issue to which the person doing the redirecting can better respond. While it is similar to the avoiding the issue fallacy, the red herring is a deliberate diversion of attention with the intention of trying to abandon the original argument.

Ad hominem fallacy – group of argumentation strategies that focus on the person making an argument rather than their viewpoint.

Tu quoque is a type of ad hominem argument in which one discredits a position by asserting that the proponent has acted contradictory to their stated position. Despite its surprising effectiveness as a persuasion tool, it is classically considered a logical fallacy.

Attribution bias refers to the negative tendency of an individual to judge a person on their character rather than the circumstances responsible for their particular action. Examples are giving coaches credit for good teams that happen to have superior athletes.

Presentism is judging the past by today’s values or standards.

Naive realism – the sense we see the world as it actually us rather than as it appears from our own perspective.

Soft bigotry of low expectations and tyranny of low expectations

One of the worst things you can do to someone, besides do something for them that they should do for themselves, is not expect much out of someone. People in general will rise to the level that those around them expect or fall to the same standard. Many people, agencies, and governments have hurt those they are trying to help through soft bigotry of low expectations. As the the old saying goes, the road to hell is paved with good intentions. Teach someone they were treated unfairly and should feel like a victim and you’ll keep them a victim for life. White liberals do this with African Americans a lot.

Hegelian Dialectic

Story as old as time.

Universe 25 experiment

Interesting because people love to try to compare to human population growth.

Kubler Ross Stages of Grief

The following is from an email but I can’t find it in his blog to link to so here it is.

It was the similarity to grief that learning of any form causes. Once I tell you, you to will see it in colleagues, patients, friends.

Denial
Anger
Bargaining
Depression
Acceptance

A new idea comes out, Socket shield perhaps.

  1. Write blog explaining why it’ll never work! (denial).
  2. This is a terrible idea and those that do it should be reported to someone (said in angry voice).
  3. Well, perhaps it works, but older methods work better! I don’t trust it. (bargaining).
  4. You remember all your denials and anger when the procedure becomes widely accepted and feel down about being so wrong. (depression).
  5. Stand up in front of audience and show a case… (acceptance).

It’s important to know that we do not necessarily go through them in this order. The timeline is not equal (we can get stuck in one for a long time). And we may not go through the process at all and just move straight to acceptance. You can see your friends and colleagues go through this process every day online. Often the anger is not directed at you personally for upsetting their world, but is the normal reaction to a shocking change. Even if it is just in their dental knowledge world. It is because of the mistaken belief that learning is a smooth gradual thing, which generally it is not. Learning is made up of sudden jumps in learning where something “clicks” and we suddenly understand. However, we can resist the new information or the better way for a considerable time.

I’m subject to this as much as anyone. I’ve resisted new learning often. Been angry at those doing things different to me. Realized that the new learning that supplanted the old, has now been supplanted by the resurgence of old ideas. The cycle is continuous and endless although being aware of our reactions to things does make them less bothersome.

We also see it in our patients.

One of the reasons that the second opinion always gets the job is because by the time the patient gets to them, they are starting to accept the idea that they need significant expensive treatment. They can do the the “bargaining” stage with the new dentist, who can give the patient the slight changes that make the treatment acceptable.

When the process becomes dangerous is when dentists who lack self-awareness see things that make them angry. It might be that they are justified in their anger. However, I’ve seen cases where a specialist endodontist in a position of power in this country, gets angry at some of the modern concepts of non-intervention at radiolucencies and would use his position to punish those that move to this more patient-centered way of thinking. I see similar quite frequently in the UK, where people (often who have little or no private clinical work) use un-elected positions of power (elitism) to attempt to punish those that have ideas different to themselves (they get stuck in the denial/anger stage).

https://en.wikipedia.org/wiki/Elitism

So if you challenge, expect to see these emotions surface. And remember, you cannot force someone to learn. Trying to make someone learn something is fruitless and counterproductive. They will learn when they are ready. It’s why it’s sometimes better to exit an online discussion than to try to continue to the point that the other party acknowledges your rightness. It’s usually impossible for them to come to that point in a short timeframe.

– Linc, Gayle, Jynni, Nicole and Erin
Restoring Excellence Team

Image of the Kubler Ross Grief Cycle

I cover a few others that are more directly impactful to dentistry in the placebo blog.

 

Random interesting stuff.

Our sense of touch, then, arises from an exceedingly complex interaction between electrons around the molecules of our bodies and those of the objects we encounter. From that information, our brain creates the illusion that we possess solid bodies moving through a world filled with other solid objects. Touch doesn’t give us an accurate sense of reality. And it may be that none of our perceptions match what’s really out there. Donald Hoffman, a cognitive neuroscientist at the University of California, Irvine, believes that our senses and brain evolved to hide the true nature of reality, not to reveal it.

“My idea is that reality, whatever it is, is too complicated and would take us too much time and energy [to process],” he says. Discover magazine 2018

Ignorance of causes

When we do not understand how/why something occurs we tend to anthropomorphize the subject. Happens with natural events. God causes earthquakes or floods. nice discussion page 76 of Mindwise by Epley.

Curse of knowledge

The lens of expertise works like a microscope.  The curse of knowledge is a cognitive bias that occurs when an individual, who is communicating with other individuals, assumes that other individuals have similar background and depth of knowledge to understand. Hard to put yourself in their shoes.

Kali yuga

Not sure how much Kali Yuga really correlates to what the graph says. There are 4 world ages and Kali Yuga is the final and worst. There seems to be debate of both how long Kali Yuga lasts and if it has ended already. However, the basic idea of the graph is consistent with the human experience and populations in general. Like many things from religion, I feel there is basic human truth intertwined in the story telling that was necessary to spread information in a time period when story telling was the primary source of knowledge for humans.

Kali Yuga

Victimhood

Some of these politicians pushing the victimhood mentality are running a grift. They get federal paycheck and public attention in exchange for saying things that make disaffected people feel embowered, while not doing anything tangible to better their situation. Matthew McConaughey speech is awesome. Victims are great at continuing to find ways and see themselves as victims through the the Baader-Meinhof Phenomenon or Frequency Illusion as seen in examples in that section.

“Let me never fall into the vulgar mistake of dreaming that I am persecuted whenever I am contradicted.” Ralph Waldo Emerson

“Being easily offended is a sign of weakness. A sign you lack the most basic fortitude to tolerate discomfort or difference.” SEERUT K. CHAWLA

Jail and mental health

Jail and mental health

Media

‘Let me control the media and I will turn any nation into a herd of pigs’ or some variation of that is linked to Joseph Goebbels. It is unlikely he ever said it in a manner that would allow it to be written or known that he did say it though. This may simply be due to the fact he was a master propagandist and such a statement would be detrimental to his agenda if it was known about.

Scare tactics

Best to use on those that make decisions more through emotion than logic.

Great quotes

“Watch your thoughts, they become words;
watch your words, they become actions;
watch your actions, they become habits;
watch your habits, they become character;
watch your character, for it becomes your destiny.”   FRANK OUTLAW

“Don’t be overheard complaining…Not even to yourself.”   Marcus Aurelius
“Love the hand that fate deals you and play it as your own, for what could be more fitting?” Marcus Aurelius

“There’s people in society that do things and there’s people in society that talk about people that do things. Let’s not forget we need the doers. we should all strive to be a doer and encourage others to be a doer as well.”

“The sign of intelligence is that you are constantly wondering. Idiots are always dead sure about every damn thing they are doing in their life.” – Jaggi Vasudev

“People who talk incessantly about “change” are often dogmatically set in their ways. They want to change other people.” – Thomas Sowell

“I learned that very often the most intolerant and narrow-minded people are the ones who congratulate themselves on their tolerance and open-mindedness.” Christopher Hitchens

“There is nothing either good or bad, but thinking makes it so” from Hamlet

“Nothing in this world is worth having or worth doing unless it means effort, pain, difficulty.” – Theodore Roosevelt (NYPD Commissioner, 1895)
Alexander Fleming once said, “The unprepared mind cannot see the outstretched hand of opportunity.”
“I can accept failure, everyone fails at something. But I can’t accept not trying.” Michael Jordan
“A step backward, after making a wrong turn, is a step in the right direction.” – Kurt Vonnegut
“If you had to choose one moment in history in which you could be born, and you didn’t know ahead of time who you were going to be–what nationality, what gender, what race, whether you’d be rich or poor, gay or straight, what faith you’d be born into–you wouldn’t choose 100 years ago. You wouldn’t choose the fifties, or the sixties, or the seventies. You’d choose right now. If you had to choose a time to be, in the words of Lorraine Hansberry, “young, gifted, and black” in America, you would choose right now.” Barack Obama
“The most sinister of all taxes is the inflation tax and it is the most regressive. It hits the poor and the middle class. When you destroy a currency by creating money out of thin air to pay the bills, the value of the dollar goes down, and people get hit with a higher cost of living. It’s the middle class that’s being wiped out. It is most evil of all taxes.” ~ Ron Paul

“One of the sad signs of our times is that we have demonized those who produce, subsidized those who refuse to produce, and canonized those who complain.” ― Thomas Sowell

“The beauty of doing nothing is that you can do it perfectly. Only when you do something is it almost impossible to do it without mistakes. Therefore people who are contributing nothing to society, except their constant criticisms, can feel both intellectually and morally superior” Thomas Sowell

“Mercy to the guilty is cruelty to the innocent.” ― Adam Smith

“The snake which cannot cast its skin has to die. As well the minds which are prevented from changing their opinions; they cease to be mind.”― Friedrich Nietzsche

“But I think that no matter how smart, people usually see what they’re already looking for, that’s all.”   – Veronica Roth

“The eye cannot see what the mind does not know” – Sir William Osler

“When hero stumbles, the cowards rejoice.” – Dave Chappelle

“He who sweats more in training bleeds less in battle.” ― George S. Patton Jr.

“It is dangerous to be right in matters on which the established authorities are wrong.”  Voltaire

“Don’t just teach your children to read… Teach them to question what they read. Teach them to question everything.” George Carlin

“How many legs does a dog have if you call his tail a leg? Four. Saying that a tail is a leg doesn’t make it a leg.”  Abraham Lincoln

“Human beings are born with different capacities. If they are free, they are not equal. And if they are equal, they are not free.” — Aleksandr Solzhenitsyn

“Those who make peaceful revolution impossible will make violent revolution inevitable.” – John F. Kennedy

Poems

Good Timber

    by Douglas Malloch

The tree that never had to fight
For sun and sky and air and light,
But stood out in the open plain
And always got its share of rain,
Never became a forest king
But lived and died a scrubby thing.

The man who never had to toil
To gain and farm his patch of soil,
Who never had to win his share
Of sun and sky and light and air,
Never became a manly man
But lived and died as he began.

Good timber does not grow with ease:
The stronger wind, the stronger trees;
The further sky, the greater length;
The more the storm, the more the strength.
By sun and cold, by rain and snow,
In trees and men good timbers grow.

Where thickest lies the forest growth,
We find the patriarchs of both.
And they hold counsel with the stars
Whose broken branches show the scars
Of many winds and much of strife.
This is the common law of life.

Geopolitical goals

Russian goals which to some extent are successful but to larger extent our western ideas have infiltrated them to a larger extent. Yuri Bezmenov

 

The best Venn diagram

Venn Diagram