In one of my very first columns for TechRepublic, way back in 2001, I made the following comments:
It’s widely acknowledged that doctors, lawyers, engineers, and architects are professionals. Is IT consulting a profession? IT consultants also draw from a highly specialized body of knowledge that is sufficiently obscure so as to be understood only by a small cadre of specialists. Like doctors, lawyers, and engineers, we spend a significant part of our working lives explaining complex technical subject matter to clients. Our clients rely on the advice we give to be successful in their careers or businesses. We also have a responsibility to provide complete and correct advice.
How Doctors Think, by Dr. Jerome Groopman, delves into the thought processes of doctors as they meet a patient, evaluate that patient from their first encounter all the way through the clinical process, and as they diagnose and treat that patient. It also highlights the unconscious biases and thought patterns that can lead doctors astray, driving them to jump to faulty conclusions, to reach for familiar remedies, and to allow their judgment of the patient as an individual to sway their decisions about the right course of action.
Why would I write a column for IT consultants about the clinical practices of physicians? Because the same sorts of prejudices, biases, or faulty thought patterns can also affect consultants, and have the potential to distort the consulting relationship and trick us into prescribing remedies that are inappropriate for the client. I believe that consultants, like other professionals, have a responsibility to examine their preconceptions and responses, and to make sure that the advice they give is based on a clear reading of the “patient’s” best course of action, and not on unconscious triggers that may lead us, and our clients, down the wrong path.
Groopman, in writing his book, has the advantage of a tremendous field of research studying the diagnostic practices of physicians. For dozens of academic studies, researchers have followed doctors through their diagnostic process and tried to analyze and capture the internal decision tree that doctors follow. This is done to document “best practices” in order to improve outcomes, and to help doctors recognize some of the misleading pathways they may follow when the err.
A straightforward example that most consultants will recognize relates to the rapport between doctor and patient. In a study done by Judith Hall, a psychologist at Northeastern University, the simple matter of liking between the patient and the physician seems to have a significant impact on the ability to diagnose. Any consultant with field experience will confirm this — difficult clients are much less prone, in my opinion, to get the same level of “care” and diagnostic effort than clients with whom we bond and develop mutual respect. “A doctor is supposed to be emotionally neutral, and we know that’s not true”, says Hall of her findings. Consultants should be neutral as well, but that can be difficult with badgering, complaining, uninformed, or know-it-all clients. This example is obvious, but some other forms of bias may not be.
Take, for instance, the pathway known as “confirmation bias.” When this bias is applied to diagnostics, doctors see, or emphasize, only the symptoms that confirm their earliest diagnosis, and ignore symptoms that tend to refute it. Every consultant has met a colleague who comes to the engagement with a pre-conceived solution, only to find that every client is in fact a perfect candidate for their solution, by ignoring any contradictory evidence. Consultants have the responsibility to ensure that they’re considering alternative solutions and not allowing their preferences to overrule their diligence.
A related prejudicial decision path is known as “anchoring,” in which we take a shortcut to diagnosis by latching on to the first available solution to the problem, without considering multiple possibilities. I’ve unfortunately seen rookie consultants and IT engineers become anchored to a perceived solution, and then become so emotionally wedded to their idea that they’ll spend longer trying to prove their original anchored response was correct than they would have spent exploring dozens of alternatives.
A related cognitive bias is known as “availability bias,” in which a doctor quickly diagnoses a condition because it resembles a case they’ve seen recently, and so is most available to mind. This syndrome is just as likely to manifest in consultants as in physicians.
Framing, or diagnostic momentum, is another decision pathway that can lead to error. In medicine, every patient has a medical record that follows them from doctor to doctor, and that record often includes pre-formed diagnoses that can influence future encounters. If the previous doctor notes that the patient is “a dramatic personality who needs attention,” how likely is it that the next physician will hear out their complaint and take it seriously?
This goes beyond personality; if a previous engineer tells a consultant that “this client’s infrastructure is a mess and they don’t upgrade their software to supported versions,” how likely is it that the new consultant already has made a diagnosis before even encountering the client? Mature consultants take the opinions of colleagues into account, of course, but they also leave enough cognitive space to discover for themselves what the issue is, and to uncover a completely different diagnosis if that’s what the situation reveals.
With all of the similarities in ways in which physicians and IT consultants can go wrong, there’s one big difference: Lives are not typically at risk when we misdiagnose. From the standpoint of professionalism, however, that distinction is less meaningful than it appears. Lives may not be at risk, but reputations and relationships (on the client and the consultant side) and livelihoods might be.
Professionalism requires us to ensure that we consider our own erroneous pathways and preconceptions, and that we come to each engagement from as neutral and unbiased a position as possible. I found it comforting to know that the medical profession is astute enough to recognize that they are human and bring their own prejudices and faulty perceptions to the patient interaction; I hope that consultants, as well, can be mature enough to examine our own preconceptions and try to bring our clearest judgment to the client relationship.
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