Shoemaker and Quasi-Magical Thinking

Posted By Grant Forrest |  last update 22-May 2012

Whilst listening to a passionate speaker at today's Harrogate meeting talking about the pronouncements of NICE on the role of Oesophageal Doppler and Early Goal-Directed Therapy (EGDT), a few poorly-connected thoughts were rolling around in my head.

• Over the course of the last 20-odd years post-Shoemaker we have accumulated a substantial body of confusing and contradictory research on the topic of EGDT
• No-one seems to agree on what constitutes “adequate statistical power” in these studies, and there is a general concern about type I and II errors.
• In his book “How Doctors Think”, Jerome Groopman reports a conversation with a Cardiology colleague, who confesses : “There are aspects to human biology and human physiology that you just can't predict. Deductive reasoning doesn't work for every case.”He discusses the tendency of clinicians to disregard uncertainty and also to engage in Magical Thinking when discussing outcomes with patients. "Quasi-magical thinking" describes "cases in which people act as if they erroneously believe that their action influences the outcome, even though they do not really hold that belief".

If we're honest, we'd have to admit that we're unable to say whether EGDT is good, bad or a waste of time and effort. Perhaps when we understand the pathophysiology properly, we might begin to creep towards an effective treatment, rather than the apparent confirmation bias-fest that we seem to have reached.