Expectation Bias in the Medical Profession

 I’ve had a couple of experiences in the past several months which have caused me to ponder the subject of expectation bias, particularly as it relates to doctors and treatment. In this post I’m going to call it EB, since that is a lot easier to type. I’m not a psychologist but merely a layman who, at the age of 78, has to deal with doctors a great deal.

EB is the human trait by which we develop preconceived notions about how a situation began or how it will work out. If we expect something to happen we are surprised if it doesn’t. All humans, I suspect, are subject to this trait to one degree or another. Sometimes this can work to our advantage and at other times it can be a detriment to our problem solving skills.

Let me describe my recent medical problems and this will illustrate expectation bias more clearly. The first involved a severe pain I had developed in, to put it as delicately as possible, my rectal area. This pain was so severe that, for several months, I couldn’t sit for more than a few minutes at a time. It was very debilitating to say the least. I couldn’t drive without suffering excruciating pain and it was always on my mind.

Finally, I went to my primary care doctor and told him my problem. He gave me a referral to a colo-rectal surgeon whose first available appointment was 60 days out. The examination during this first office visit was so painful that he was unable to see anything. The next office visit had the same outcome. Finally the surgeon decided that surgery was the only way to do a proper exam.

A couple of weeks later, I had the surgery and he told me afterwards that he could find no reason for my pain. About a month later, the pain was getting even worse than it had been and I went back to see him again. This time he saw something he didn’t like the look of – he casually asked me what I was doing the next day and I told him “nothing”. With that, he asked me to come back to the hospital for another surgery. I had apparently developed another problem.

I did have the surgery and he repaired whatever he had seen. This did nothing to ease the pain, though. It finally subsided about four months after the second surgery with no known events to cause it to subside.

However, in January, 2025, the pain returned, as bad as it had ever been. I had one more visit with the surgeon who admitted that he had no idea what was causing it. In June, my wife was searching the internet for clues and stumbled across a condition called pudendal neuralgia which appeared to be very similar to my symptoms.

The best way I can describe this is that it’s like having carpal tunnel syndrome in your pudendum, which is a nerve sheath which controls all your lower trunk functions, including the rectum. One treatment for this is a prescription called gabapentin, which is most often used to treat women after hysterectomy surgery. A close friend had a prescription which she had not taken and offered it to me. Eureka! Within three days of beginning it, the pain subsided and, to date, has stayed away.

Three case of EB were present here: 1) Me for assuming that my pain was in my rectum, 2) the primary care doctor for believing me and, 3) the colo-rectal surgeon who looked no further than his past experiences to treat me. We were all apparently misled by our own expectation biases.

While all of this was happening, my knees were also beginning to cause me a great deal of pain. I again went to the primary care doctor, this time for a referral to a knee surgeon. I even specified the surgeon I wanted to see. This was the “same song, different verse”. After a couple of months, I got in to see the surgeon and he had x-rays done, which showed nothing.

After two or three visits, including steroid shots and an MRI, he still couldn’t find any reason for the pain. He finally did what I call a “courtesy surgery”, ostensibly to trim the meniscus in my left knee. I call it a courtesy surgery because I suspect he did it primarily to placate me. None of these treatments had any long-lasting impact – the steroid shot did help for about 30 days, then the pain returned.

Finally I went back to my primary care doctor who reviewed my symptoms. He said that he wanted to run some blood tests which are not typically done. Sure enough, one of them revealed the root cause of my joint pain, gout. Yes, it appears that my knee joint problem was caused by gout

He gave me a prescription for allopurinol, a drug which is commonly used to treat gout. It took close to a month for this stuff to work but eventually it did. I now have no pain in my knees.

As in the first example, three cases of EB occurred, delaying my treatment. This time I even contributed to it further by specifying the knee surgeon I wanted to be referred to.

How do you overcome expectation bias? I don’t think you can but, if you are aware that it happens perhaps you can deal with it better and make smarter decisions.

(Clarification Note – when I refer to doctors, I’m also referring to their assistants, most notably physician’s assistants.)

International Travel, Part 2

 

In my last post, I talked about my travels in the late 1970s to Mexico and Venezuela. This post picks up where that one left off.

One of the most pleasant business trips I ever took was in 1980, when I traveled to New Zealand and Australia. Our company operated manufacturing facilities in both countries, and they were actively exploring new product lines. Vickers New Zealand had taken an interest in our power take-off (PTO) product line and reached out.

Sid Leivers, the manufacturing manager at Vickers New Zealand, contacted our general manager, Roy Golze, to ask if I could visit their plant to discuss producing PTOs locally. I had spoken with Sid many times before and had even sold him PTOs for resale. He and I had a good working relationship, so I was glad to get the invitation.

Roy Golze was a bit of an odd character. He told Sid I could make the trip, but only if Vickers New Zealand covered all travel costs. After some internal discussion, Sid and his team agreed. A round-trip ticket on Air New Zealand was purchased, and I began preparing for the journey.

Because of the long flight from Los Angeles to Auckland, refueling stops were required. We landed in Honolulu on the way there and in Papeete, Tahiti on the way back. I can now technically say I’ve been to both Hawaii and Tahiti—though I never left the airport at either location!

Sid met me at the Auckland airport and informed me I’d be staying at his home with him and his wife, Norma. What a memorable experience that turned out to be. Staying with them allowed me to get a feel for everyday life in New Zealand and to know them on a personal level. I can’t say enough about the kindness and hospitality that Sid, his family, and his staff extended to me.

The two weeks in New Zealand flew by. When it came time to leave, I had a short flight to Melbourne, Australia, where I visited the Vickers plant there. Though my stay in Australia was brief—just a couple of days—I was treated just as warmly as I had been in New Zealand.

On September 28, 1980, I boarded a flight from Sydney to Auckland, then prepared to head back to Los Angeles. That’s when the first hiccup of the trip hit: the ground crew for Air New Zealand had gone on strike. As a result, there was no food or drink service at all—not even a glass of water—on the leg to Papeete. Knowing this made the already long flight feel even longer. That wasn't my last bad experience with Air New Zealand; I’ve sworn off flying with them ever since.

Fortunately, the final stretch from Tahiti to Los Angeles was uneventful. I connected to Tulsa, and before long, I was sleeping soundly in my own bed.

By 1982, things had changed at the company. Roy Golze had been dismissed, and Jerry Rice—my longtime mentor—returned to Tulsa to take over as general manager. Within a year of his return, I was promoted to marketing and sales manager. The new role came with significantly more travel, both within the U.S. and overseas.

During that period, I found myself making frequent trips to Canada and across Europe—part of a chapter that deserves its own post.

International Travel - Part 1

I consider myself extremely fortunate to have been able to travel to many places, some outside the United States, in my lifetime. Most of these trips, in the early days, were connected to my work. After I retired, Louise and I had a chance to visit many places as well.

I’m not really sure about my first time to leave the U.S. - it was probably in 1971 when we got transferred to Detroit with my job. Detroit is, of course, right across the river from Windsor, Ontario and I do remember us going over there. During that time, I also made a few sales calls in Toronto.

In 1978, my job title was Product Manager. In that role I was responsible for long range planning for the three product lines we had. My next big travel adventure spanned a period of about eighteen months when the Company decided to start manufacturing winches in Mexico. I was assigned to be the liaison to our Mexico City plant to get this project started.

During this period, I traveled to Mexico about nine times. These trips were always pleasant and the people I worked with were enjoyable. Although most of our time was spent in Mexico City, we did get out and see some of the Mexican countryside.

I remember that, on one occasion, we drove up the eastern coast to Tampico and called on a cane sugar processing plant. While on that trip, we stopped at a roadside cafe for lunch. It was a thatched roof hut with dirt floors and we had cabrito (roast goat) for our meal. It was delicious!

The manufacturing program, however, did not succeed. The labor rate in our plant in Tulsa was about $8.00 per hour at the time, compared to Mexico City’s $1.00. Inefficiencies in their plant more than offset this labor difference and another bust cycle in the oilfield hit; the program was stopped after a couple of years.

In early 1979, I became the International Sales Manager and my long distance travel really began. My first really long international trip was made in March, 1979 when my boss told me to go to Caracas, Venezuela to call on a customer. Being young and adventuresome, I was thrilled.

After consulting some maps, I discovered that another customer was located nearby, in Port of Spain, Trinidad and Tobago, so I planned a stop there to see him.

As I recall, my sales call there was uneventful and cordial. That afternoon, after I had checked out of the hotel, I went to the airport to catch my flight to Caracas. I was booked on a flight on Aeropostal, an airline owned by the Venezuelan government.

This was where I began to realize that I was not in the U.S. After about a two hour wait at the airport, the woman at the desk made a PA announcement that the captain had decided not to fly that day. She suggested that we come back the next day when he might feel like flying. Fortunately I was able to get a hotel room where I had stayed the night before.

Sure enough, the next day the captain felt like flying so we headed for Caracas, about a two hour flight. However, the rest of the trip just “went downhill” from there. We had a sales office in Caracas, manned by Venezuelan employees. They had made my room reservation for me and the hotel they had selected was squalid!

I was on the fifth floor and the elevators only worked occasionally. Worse than that, however, was the fact that the room had no lock on the door. I was in Caracas about a week and slept with my passport under my pillow the entire time. That still wasn’t the worst part of the trip.

A Cincinnati company had sold a plastic injection molding machine to a customer in Caracas and it was having hydraulic issues, specifically with a motor that our company had provided. A service technician from Detroit had traveled to Venezuela to fix the problem but told the customer that he would have to return to the U.S. to find a solution.

This did not suit the customer at all so he stole the technician’s passport to prevent him from leaving. All of this was happening right in front of me! When I returned to the U.S. the next week, I telephoned the guy’s boss to find out if he had been freed. At that time, he had not but a couple of weeks later he was released.

Fortunately, I wasn’t having that kind of problems. However, when I got ready to leave I encountered another problem. I was booked on a Pan Am flight to Miami on a 747. I got to the airport, boarded the plane, and it taxied out to the end of the runway. And we sat there – and we sat there! Finally, after about two hours the captain come on the intercom and announced that the only reason we weren’t airborne was because the Venezuelan government was harassing us. You could tell by his words that he was extremely mad. After another hour or so, he finally got his takeoff clearance and we left! When I got back to Tulsa, I told my boss to not ever try to send me to Venezuela again.

I’ll pick up on my continuing travel on the next episode.

Skeletons in the Closet

A couple of weeks ago, I saw a post on Facebook that was interesting. A fellow named Kevin Heaton had written a book which sounded interesting and was centered around my home town, Mannford, Oklahoma. Although I didn’t know Kevin, I did know his parents and also several of the people written about in the book. The subject of the memoir was Opal George, Kevin’s mother-in-law, and the name of the book is, appropriately, “Opal”.

I quickly ordered a copy from Amazon and received it in a couple of days. When I read it, I was surprised to see that one of my distant relatives, Raymond Wyatt, was mentioned. He and Elva Workman were two of Mannford’s most unusual characters.

If you do genealogy long enough, the skeletons are surely going to come out of the closet.  In my case, I've had several.  Some people don't like to talk about certain of their relatives but I think, in most cases, it's terribly funny.

Let's start with Alvie Workman.  Elva W. “Alvie” Workman was born in Miller County, Missouri, on March 16, 1892 to Richard Ellis Workman and Sarah Malissa (Gilliam) Workman. They were both native Missourians and both had been born in Miller County. Miller County is located in the south central part of the state. Richard was a farmer all his life as were most folks in that era.

Alvie was the oldest of three boys born to that marriage. Sarah died in Miller County in 1926 at the age of 56 and Richard died in Perry, Noble County, Oklahoma, in 1959 at 89 years of age. He had moved to Perry to live with his son, Thomas, when he became too old to work.

Alvie moved to the Mannford, Oklahoma area sometime between 1900 and 1910.  In 1917, he married Ida Jane Ihrig, my father's first cousin.  Alvie and Ida had a total of six children, all boys between 1918 and 1928. In the late 1920’s, he was arrested several times for “moonshining”, operating an illegal whiskey still. This was not uncommon, however, for prohibition was the law of the land from 1920 to 1933.

Ida Jane was the fifth child and third daughter of Francis Marion Ihrig and Mahala (Stephens) Ihrig and was born in 1899 in Indian Territory. Mr. Ihrig was also a farmer in the Mannford area. As a side note, one of Ida Jane’s siblings was Ernest “Twenty” Ihrig, a well known cowboy in Mannford and a “side kick” of Milton Walker “Cap” Alexander, the foreman of the Wilson Ranch in that town. An article about that ranch appears in a 2019 blog.

Sometime between 1940 and 1950, Alvie and Ida Jane separated. In 1950, he was still living in Mannford and listed his marital status as “separated”. Ida Jane had moved to San Mateo, California and listed her marital status as “widowed”.

In the early 1950’s, when I was about six years old, I became aware of who Alvie Workman was. My father told us children about how we were related to him. By this time, he had become one of Mannford’s “characters” and was feared by most of the children in the area. He was a tall, gaunt man who had extremely long hair and a long beard.

The story goes that he was possessed by demons. He lived in a tar paper shack down by Hazel Creek on the east side of town. Even with his idiosyncrasies, Alvie was a hard worker and did a great deal of labor, mostly for Raymond Holmes, the local hardware store owner. He was also a very adept whittler and made many a cane for people in Mannford. You could tell by his work that he had a great deal of innate artistic talent.

In the late 1950’s, Alvie began to travel back and forth from Mannford to Lebanon, Missouri. Hitchhiking and hopping freight trains were his preferred modes of travel. He died in August, 1981, and is buried in the Cemetery in Lebanon.

Raymond Wyatt was born on April 12, 1905, in Bowie, Montague County, Texas, about 90 miles northwest of Dallas. He was the son of Albert Lee Wyatt and Calvin “Callie” Horton Wyatt, both of whom were native Texans and who had wed in Montague County in 1902.

Not long after Raymond was born, the young family moved to Hazlip Township in Creek County, Oklahoma. No reason for their move has been found, although Albert had a half brother, Thomas Perry Porter, who had come to Keystone, Oklahoma, nearby, in 1902. The Wyatt family lived in the Mannford area for several years and Albert enrolled his son, Raymond, at Flat Rock School at the age of ten. It is suspected that he didn’t attend school for very long.

Sometime before 1935, Albert and another half brother, Doss Porter, left Mannford and headed for California. Doss took his family but Albert left Callie and young Raymond in Mannford. Callie worked at several jobs after Albert left and even had her own grocery store at one time. Raymond, without the influence of a father, began to drink heavily and got involved with bootlegging and moonshining.

The great prohibition “experiment” in the United States began in 1920 and lasted until 1933. Even after prohibition was lifted, the State of Oklahoma remained legally dry until 1959, with only 3.2% beer being allowed. In practice, however, bootleggers and moonshiners kept the State in alcohol.

It was sometime in the mid-1930’s when Raymond received his nickname, “Slip” or “Slippery”, so called either because of his ability to escape deathor to elude law enforcement. He had many close calls. Also, at one point, he admittedly ran a “still” up in “East Holler”, just east of the town of Mannford.

Slip’s exploits were many: In 1932, he stole a car from another Mannford resident and fellow moonshiner, G.W. “Jack” Housley, and later wrecked it. At the time, it was expected that he would never face charges for the theft because he was critically injured when he wrecked the car. Obviously, he did recover but the outcome of the car theft charge is unknown.

In 1937, he was shot in the stomach by Mannford’s constable, C. E. Woodruff after resisting arrest for disorderly conduct. Apparently, he, Slip, had gotten into an argument with Woodruff’s son where hatchets and hammers were involved. Slip was, of course, very drunk. He was taken to Oklahoma City where he recovered in a hospital there. Charges against him were later dismissed.

At the time of the 1940 U.S. Census, Slip was incarcerated at the state penitentiary in McAlester, Oklahoma. The reason for his stay there is unknown but he did spend several stays there and in jails around Creek County.

In fact, in 1949, Slip made the national news when he wrote a postcard from Phoenix, Arizona to the Creek County Sheriff, Lee Johnson. Slip had walked off his trusty job with 30 days left to serve on a public drunkenness sentence. The card read:

“Dear Lee, do you want me to come back? I am sorry I run off. Tell all the boys hello for me. Yours truly, Slip Wyatt”

The sheriff commented that he would spend no county money to bring Wyatt back. When Slip had been booked into the jail on the public drunkenness charge, he had listed his profession as “moonshiner”. Wire services had picked up the story and it ran in many newspapers across the country.

In yet another event,in 1945, Slip was charged with grand larceny when he stole two pairs of reading glasses and two sets of false teeth, along with $65 in cash. The outcome of this case is unknown, as is what he planned to do with the false teeth. Again, the victim in this case was his friend, Jack Housley.

In all, the number of times he was arrested is more than can be counted. Charges included public indecency, public intoxication, driving while intoxicated and several others. In spite of all these run-ins with law enforcement, Slip was regarded as a likable fellow around Mannford.

In the early 1960’s, Keystone Dam and Reservoir were being constructed and the town of Mannford elected to move. Many of the residents moved to the new town location but some went elsewhere. It was around this time that Callie Wyatt decided to move to Oilton, about 16 miles away. Slip, who had never married, moved with her.

On July 10, 1967, Raymond “Slip” Wyatt passed away and is buried at the Drumright North Cemetery in Drumright, Oklahoma. No cause for his death can be found but, with the way he lived his life, anything would have been possible. His mother, Callie, died in Oilton in June, 1973 at the age of 91 years.