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.)
