The Dunning Kruger Myth

Human knowledge is a funny thing.

We are all built to feel like we know what we know, when in reality, this is likely not the case. Or at least much less solid than we feel it is. 

With things like memory, certainty, confidence and opinions, we so often overestimate the accuracy of our own knowledge.

You can see why this would be an advantage from an evolutionary perspective.

Having confidence in your view of the world makes it easier to act - to decide, move and take action towards survival.

Be it run away, fight, find food and shelter. The do-ers of our evolutionary line have helped us thrive.

However, before we get too self-congratulatory, we must remember the action takers that tried, failed. And died.

The ones that said fuck it and gave it a crack.

“This mushroom looks pretty tasty”

“That ravine isn’t that wide”

“That bear isn’t that big”

So while confidence in our thoughts and actions has evolutionary reasoning, it doesn’t mean we should take that as proof that our guts know what is a good decision. Just that it knows what it feels like to be confident. And it likes it. FISJAM - Fuck I'm smart, just ask me.

Whether things work out for us has a lot more to do with random chance than strong reasoning skills.

Luckily then, humans invented philosophy, reasoning, the enlightenment, all these things to help actually know what is going on, right? Right?

Not being a philosopher, but having read some philosophy, I realised pretty fast that they don’t know what the fuck is going on either.

The good ones realise this, and exist in some existential funk, having pulled themselves out of the Matrix to see things as they really are, realise we actually know fuck all and never will and are just specks of dust hurtling though space on a giant rock, and ease into a drug-induced stupor to fuzz out the questions they can’t answer and eventually die a blissful death from syphillus.

The dangerous ones invent a model of the world that they lend their name to, and spend the rest of their lives shoehorning all of human existence into this model.

Health professionals are pretty good at this too, come to think of it.

So the short version of that is - no one really knows anything, but we like to think we do, and we like to tell other humans how much we know.

This overconfidence in our knowledge, the more limited it is, is so common it was researched and published and, in great scientific tradition, given the names of the people who popularised it - Dunning and Kruger.

Health professionals are exposed to this a lot. In the age of information, people have access to the internet and loud idiots who give them a lot of noise, but not a lot of quality. So people will have ideas of what causes pain, what to do about it, and how many garlic cloves to shelf while they walk around in the shoes with fingers, eating charcoal.

I am taking the piss and trying to be funny, but the more delicious thing is I don’t even need to try. It is hilarious the amount to which humans really overestimate their knowledge, even when they are aware of it.

And I will turn my laser on myself first, then health professionals next.

I know about this effect. And yet I will constantly hear myself making proclamations about things I have next to zero reasons for confidence, other than my own sense of how right I am.

“There is no way it is going to rain”

“It’s definitely left from here”

“There was another cookie left when I took one, I didn’t take the last one”

All the time. Certain proclamations about the state of the world. That are probably or definitely wrong.

The trick is the domain in which I am happy to be certain and wrong. It is unimportant matters outside professional domains where others have a lot to lose. If I tell my wife to turn left and it’s right, she will give me shit about it but no one gets hurt (maybe me, she is a hitter). 

If I tell people in pain that ask me for help that their back pain is because they’re job has given them the back of an 80 year old.

1. How can I know this? Can I prove causation in this example? No
2. Could I cause this person harm by saying this? Yes

So, in domains where there are real risks borne by people other than ourselves based on our opinions we have to be very wary of the pratfalls of our own design and be brutally and radically honest about the limits of our knowledge. And collectively we are fucking shit at this.

So - what do I mean by the Dunning-Kruger myth?

Now I will turn my attention to health professionals.

I just said DunningKruger was real and I have experienced it.

The myth part of it is that health professionals think that if they go through “the curve” of this image once they are good and now know everything.

They think of it as an experience, once surpassed, that they used to suffer.

They then carry on with even more confidence that what they “know” is the truth.

The myth is that this is some process that you have to go through.

It’s a cognitive bias, meaning it is always, ALWAYS, there.

You are built to think you know more than you do.

The truth about human knowledge is there is always more you don’t know.

Even specialists, by definition, lose sight of things outside their specialty, because they specialise.

Even within their speciality you have to be careful of their grasp of the limits of their knowledge. I want a dentist examining my teeth, rather than a pianist, but it doesn’t mean what your dentist says about your teeth is true in all possible futures and universes.

So, more accurately, as you approach the limits of your knowledge, with effort, action, fucking up but surviving and reflecting, you can break through - to the next limit. And continue until you die. The winners in this scenario realise this and enjoy the journey. I see 2 types of losers. The ones that realise and stop, as it is too hard. And the ones that don’t do it and feel they are the smartest person alive.

The truth is if you feel like you have made it, know everything and can stop, you are probably just about to fuck it up completely.

There is always more you don’t know. Like you are swimming to the deep end in a never ending pool that gets deeper. Rather than wanting to know everything, or thinking you do - LEARN HOW TO SWIM FFS!!!!!

This is how things are, so learning to navigate it is by far the best way forward.

Decision making under uncertainty is Human 101. Your ancestors did just find and so will you.

But Dave, you even said some of them didn’t and ended up dead.

Well full marks for remembering.

You are correct. Some of them and some of you will make terrible fucking decisions and ruin everything for yourself and others. Right now, some of the people you know make eventually make decisions that ruin the entire fucking planet.

The key is not learning how to not be wrong, the key is learning WHERE to not be wrong

So where’s the line?

The line is CONSEQUENCE

If you are wrong, who pays the price and how much?

If it is being called a dickhead by your wife, then decide and act, free in the knowledge that she thinks you are a dickhead even when you are right.

If it is picking a movie you are sure will be awesome and it sucks ass, enjoy the 2ish hours of having your cortex occupied so you can ignore the ennui of existence.

If it is ruling out a serious bone condition for your patient so that they don’t need a hip replacement at 36, then please, pull your fucking head out of your arse and be honest with how much you don’t know and ask for help.

If it is helping people in pain, realise that reading a textbook or doing a course where you imagine things does not equip you with understanding what pain can do to people or allow you to assume what will happen with the next person you see.

Know your domain and act accordingly.

So the image of the curve of the Dunning Kruger effect does not help anyone. Like all your other confirmation biases, it is an evolutionary short cut we have all developed. Like the other biases, rather than pretending it doesn’t affect you, realise it does and work on not getting stung by it in areas where it can do real harm.

As a health professional, not knowing the answer will never hurt anyone, as long as you ask someone else or keep looking. The thing that hurts people the most is when you are so sure you have the answer and you just don’t. 

As good as you are and as much as you have learned (and I think most health professionals have way more potential to help than they think) you just can’t know everything. Especially something as variable and weird as pain.

So forget how smart you are for a second. What you are very good at right now is the helping people bit. And every person you help you get better at the helping. The best health professionals aren’t the smartest. They’re the ones who know where their real skills and value lie and have confidence in what they do, up to the point where it moves into what someone else does. They then know who the someone else is.