Thinking Tools: 25 For 2025

How do we go beyond the data and learn how to apply it in practice? After reading current research findings or learning of a new concept, how do we answer the question of, “Now what?” ?  How do we make sense of claims by enthusiastic practitioners who project a high degree of certainty in their assertions?

Many chiropractors struggle with these challenges, and I have wrestled with them over the years. In over 39 years of practice, and from teaching thousands of chiropractors over the years, I have found this is a recurrent issue. From looking at some of the social media posts recently, I can see that it’s still going strong.

Below is a brief outline of some strategies and ideas that I have learned over time that I remind myself regularly to help me meet these challenges. This is not a complete or static list. I share these for anyone who is interested and who might find value in them.

NOTE: I am not preaching to anyone by using the second person pronouns “You” or “Your”. This is more like me talking to myself. I, like you, contain multitudes.

1. Accept You’re Only Partially Right. We all work off of a theoretical mental model. A good mental model is a framework of how something works. It creates a paradigm, an internal representation of the reality we live with. It’s a lens we see the world through. A model need not be absolutely correct to be effective. A model is held to be valid when it reliably (though not perfectly) maps or predicts the observed behavior of what’s studied. A good model is effective at solving the problems it is meant to solve. All models are partially true and partially right.  Our goal is to get a little more right by updating our paradigm to make it more consistent with current evidence and experiences. 
2. Develop Discernment: Have a practice of self-awareness and reflection, using metacognition or non-judgmental witnessing. With an impartial attitude, look at your  beliefs, your experiences, and the studied research evidence. Acknowledge that “true for me” and “in my experience…” does not equal objective facts. Everyone has cognitive biases, and confirmation bias is the big kahuna of them all. When you have a vested interest in your point of view (POV) it will naturally and unconsciously influence your judgment. Discernment is about how well we are to recognize our biases and appreciate their influence on our determinations.
3. Steer Clear of Counterfeit Philosophies: Much of so-called “philosophy” in chiropractic is not philosophy in the sense of active inquiry. It is actually either dogma masquerading as philosophy, a practice management strategy in disguise, or is based on a bad or outdated theory. True philosophical inquiry is about asking questions, exploring answers, and discussing possibilities.
4. Smash Your Idols: It’s easy to get overly attached to your conventional ways of doing things. To idolize a school of thought, a personality, or a technique system that evokes a sunk cost or an endowment effect- where you’re so invested in it you feel you can’t let it go. Be willing to cut loose from theories and practices that don’t work or don’t make sense to you anymore. If an idea needs to die, don’t fear the reaper. Broken mental models are the first step toward paradigm shifts.
5. Stop Promoting Active Ignorance: This happens when we intentionally or inadvertently spread misinformation. The Dunning-Kruger effect is when we are sure we know more than we really do. This commonly shows up as having certainty about something. Certainty kills curiosity, or at least hamstrings it.  Certainty differs from confidence. Certainty shuts down and excludes. By contrast, confidence is open ended and inclusive.
6. Foster Intellectual Humility: Intellectual humility consists of four elements: Respect for Viewpoints, Lack of Intellectual Overconfidence, Separation of Ego from Intellect, and Willingness to Revise Viewpoints. Intellectual humility is simply the recognition that the things you believe in might in fact be wrong. The 3 and 4 most important words for critical thinking and intellectual humility are respectively, ” I don’t know” and “I might be wrong”.
7. Don’t Live In a Bubble:  Evidence-based or evidence-informed practice is a social process. It’s a team effort. Have a group or cadre of curious colleagues and experts to discuss how to better interpret and apply the research. . Many chiropractors live as intellectual Lone Rangers in the silos of their offices. With few opportunities to interact with colleagues on a regular basis, they develop their ideas in a bubble. We need feedback from a collaborative community to reality check our premises, and to brainstorm methods.
8. Have a  Credible Trust Proxy: Some things we need to outsource to an expert or experts who know more about these specific areas. To delegate to someone we can trust who can better vet or interpret the information. Of course, the key word here is “credible”. That’s a much bigger topic. What is important is to have confidence in the source, and following the miltary adage: “trust, but verify”.
9. Recognize Motivated Reasoning: This form of emotional reasoning seeks to confirm what a person already wants to believe or thinks is true. This includes actively searching for and interpreting information in ways that reinforce our current beliefs, explaining away information that conflicts with it, and failing to look for conflicting data. Ask, “would I believe this, support this, or take this position if it had no benefit to me?”
10. Confront Idée Fixe: when you have a fixed idea about how something works, you will be doing mental figure-8’s around it. You will engage in confirmation bias and cherry pick research to back up that preconceived position. This creates cognitive and perceptual blindspots that will require someone outside yourself to point out.
11. Look for Validation from Dissimilar or Antagonistic Sources: When a journal like JAMA publishes a positive paper on SMT, or a Spine surgeon group gives a statement supporting what we do, it has gravitas. These entities have no interest in supporting anything chiropractors do, or have an active interest in our profession not succeeding. That makes their endorsement significant.
12. Play Devil’s Advocate: Attempt disconfirmation of what you know. Try to prove yourself wrong. Know the arguments and evidence in opposition to yours and be able to argue them effectively. Make your opponent your ally in strengthening your position and uncovering the holes in your argument.
13. Accept the Reality of Growth and Change: You will be practicing differently in 10 years time or less. Don’t be such a zealot for your current point of view or approach as “it”. It will change, maybe even drastically. Updating your mental models is a sign of mental health. 
14. Conflicts Clarify: Don’t shy away from a discussion that will challenge you to clarify your thinking. These should be collegial. The goal should be to illuminate, not dominate.   Creativity and innovation is fostered by the dialectic of conflicts and their attempted resolution. While spirited debates are productive, acrimonious ones are not. If a disagreement descends into name-calling or disparaging commentary, it’s time to walk away.
15. Don’t Be a Proof Junkie: Insist on data, not just anecdata for making clinical decisions. However, don’t  look solely for research to guide or justify everything you do or say in practice. It’s estimated that less than half of medical procedures used in healthcare have moderate to high quality evidence to support them. Further, it’s estimated that it takes an average of 17 years for research evidence to reach clinical practice. Accept complexity and uncertainty. Incorporate to your decision process the clinical experiences and observations from yourself and your colleagues, your patient’s narratives, real-world data, rational determination, and old fashioned trial and error. Know when to apply non-quantitative or qualitative (i.e. subjective) analysis.There’s a reason they call what we do “practice”.
16. Address the Right Audience: When questioning or discussing a topic, make sure you’re asking the right crowd. Don’t expect a group that insists on having evidence to support a position to be impressed by your passionate opinion. Conversely, don’t expect research data to convince a group that values sensory experience as their primary means of knowing, or is committed to upholding a set of principles as a  “sacred trust”.
17. Practice Makes Better: Be willing to be a rookie. Go through the learning curve, especially the early novice phase of doing it bad or feeling like an idiot. Experience alone will not make you better. Graduated challenges, purposeful practice, feedback, and repetition over time lead to expertise.
18. Get Curious, Not Furious: On the road to mastery in any domain, you can tell where you are by your emotional reaction to new information or data that doesn’t fit your paradigm. Novices get confused. Competent practitioners get upset. Experts get curious. Masters get excited. Novices operate by rote from a given set of rules. Competent practitioners are able to apply the rules in specific situations (which is why they get upset when the rules don’t work).  Experts use heuristics (rules of thumb) they create by modifying the rules based on their experiences. Masters know when and where to apply the rules, when to modify them, and can create new ones when the situation calls for it. 
19. Broaden your Horizon: Look to sources beyond your discipline for similar problems or analogous situations to yours. Sometimes looking at how another industry, profession or genre of healing solves or handles a problem can give you insight on the one you’re facing.
20. Listen to Your Gut, but Don’t Obey it: Somatic signals and intuitive impressions are a form of non-cognitive knowing. While information from these sources should not be followed blindly or exclusively, neither should they be ignored. Clinical intuition is mostly pattern recognition, and that works primarily in situations you are familiar with. New, novel, or complex cases require more than a feeling.  Integrate embodied cognition, intuitions, empirical knowledge and analysis in your reasoning process.
21. Test Drive: Don’t immediately discount a theory or a practice without first exploring it. Reasonable people avoid the habit of taking everything at face value, or rushing to  judgement based on hearsay or assumptions. Try it out first. Treat it like an experiment. It’s also okay to say you have no interest in looking into something more deeply and leave it at that. 
22. Take What is Useful and Leave The Rest: After studying an idea or method, analyze and evaluate it to determine how much of it makes sense and is usable for you. Use that and ignore the rest. Be a student, not a devotee.
23. Don’t Ignore the Base Rate: Ignoring or undervaluing general statistical information (i.e. base rate) in favor of specific, anecdotal information can give you a slanted view.. When you focus too heavily on specific information or individual characteristics, you can generalize something that is in fact idiosyncratic. Avoid overgeneralizing. Find out the base rate of any data you come across before proceeding to evaluate it further. 
24. Figure Out the Story the Evidence is Saying: The quality and preponderance of the evidence, and the direction it’s leading tells a story about what’s so. It is a narrative that is constructed by the confluence of the research, the paradigm it’s interpreted in, and the experiences of the practitioner. To get the big picture, step back and see what it looks like as a whole.
25. Ask What’s Missing: What’s not being studied? What’s being overlooked? What might be hiding in plain sight? Caution is advised not to automatically project bad intent or deceit as a reason for exclusion. Slicing it up with Occam’s or Hanlon’s razors is not a bad idea as well.

And one more:  

26. Keep Your Sense of Humor: At the end of the day, the process of learning and discovery should be fun. There are many absurdities along the professional path. Humor has a way of putting most things in perspective and keeping us enjoying the journay. 

I may explore each of these in more depth in future blog posts this year. 

Here’s to a thoughtful and thought-full new year!