Opinion: I’m Not the Doctor for You: Cognitive Bias, Complex Illness, and a Moral Imperative, 2025, Kuon

Abstract

Cognitive Bias and the Treatment of Complex Illnesses: A Reflection on Substance Use Disorder and Long COVID. Physicians use anchoring and confirmation bias every day to make snap decisions about patient care. However, in the case of poorly understood complex illness, cognitive bias can lead to poor outcomes for the patient. This article explores how recognizing and overcoming cognitive bias leads to increased personal career satisfaction, and improved patient outcomes. In an era where health disparities are increasingly recognized, and in the post-COVID era in particular, there's a need to recognize cognitive bias against complex illnesses such as Long COVID and Chronic Fatigue Syndrome. It may even be a moral imperative.

Open access

 

Patients suffering from conditions like Long COVID and CFS often face clinician skepticism and disbelief. These reactions, which can feel like medical gaslighting, exacerbate an already challenging situation for the patient.4 Despite compelling evidence that these conditions are real, physicians often struggle to provide effective treatment due to lingering uncertainties and misconceptions.5 Knowledge deficits contribute to the problem, leaving the inexperienced and uninformed clinician to assume patients are malingering. In my current role directing the Long COVID clinic at my university hospital, I see firsthand how this skepticism erodes trust in the medical system and leads to medical care-related trauma. As one of the few clinicians with expertise in treating CFS syndromes alongside Long COVID, it also leaves a critical care gap that begs to be addressed by the broader medical community.

 

Overcoming biases may mean being open to new approaches. Multidisciplinary interventions, such as graduated exercise therapy with the Modified CHOP POTS protocol,11 incorporating pacing after energy expenditures, cognitive behavioral therapy, and neuromodulation, alongside dietary and nutraceutical interventions, have all shown promise in managing Long COVID and CFS.12 However, these treatments are often overlooked in favor of more pharmaceutical and organ-focused approaches, leaving patients to rotate from 1 specialist to another while enduring disabling symptoms.

 

OFFS

 

Ref 11 to CHOP POTS protocol doesn't work but I have found a link to this PDF document on it on the Dysautonomia International website.

 

This same doctor if they were practicing in the 80s:
(spoiler because contains homophobic stance)

Spoiler

“All you other doctors see gay people through such a homophobic lens which complicates treatment. I, as someone who cares about gay people, am qualified to provide highly effective gay conversion therapy”

 

The Helsinki Declaration 13 December 2024.

 

Don’t worry you’re getting it. That’s precisely what this is

 

To be fair, there was never a time when this type of professional didn’t promote themselves as competent well meaning actors in a sea of incompetence (see inexperienced) and corruption (see over medicalisation). It’s just that they’re now much more likely to appropriate patients own language as well as the language of fairness and equality more generally.

 

Swing and a miss.

Ah well. Shows how you can't actually beat those biases in most cases, even in those who feel like they are aware of them. Actually, it's clear that they literally can't even tell the difference.

I especially hate this line:

First of all, denial is not skepticism. It's its own thing. It's the difference between agnosticism (I don't know what this is) and atheism (this doesn't exist). But those two completely understate the consequences. It's not a passive thing, trust is not eroded by some natural phenomenon, rather it's actively destroying their own credibility.

But the trauma completely belittles the consequences. People die, including many who take their own lives in despair. Millions of people have simply continued existing miserable lives where, on their last breath, was simply not worth living. Trauma is the least of all worries here. It's destruction of human lives on an industrial scale. Entirely on purpose, that purpose being a gaslighting ideology built entirely on logical fallacies and fraudulent claims.

Even in professionals who feel like they get it, they almost always make it clear how they aren't even close to getting it. Literally pushing the exact same BS as avowed deniers, bizarrely arguing how this psychobehavioral approach is overlooked, when it's all there is. The only difference is whether it happens with a smile or a frown. Pretty much literally all the difference there is between and , for the exact same outcomes.

People truly make up whatever tales about themselves they feel is the best interpretation of their own behavior. Even when they copy exactly the very same behavior they misrepresent, distort and, ultimately, enable just as surely as those who are insulting on purpose.

Every quack in history has always been absolutely certain of being right. Especially those who were wrong. Because it usually takes misplaced confidence and a complete lack of self-awareness to start doing that doesn't work, so it's natural that the same mechanism keeps applying to make it continue, and look back at disastrous outcomes as if any of it was good.

This is why evidence-based medicine was developed. Only to be immediately corrupted into doing the exact opposite, because they literally can't tell the difference between science and fantasy.

 

The author practices in San Francisco.
Maybe @dave30th should go along looking very haggard and ask for some treatment.

 

Here comes the switch and bait - disgustingly

 

But it’s buy one get the other free, for life, whether you like it or not

once you’ve been made severe they have to rewrite your life story telling you that opptibthe truth you must have never tried moving to cover up for the fact that it was get and their deliberate short-cutting of rest that caused it

which means they then with those two inabilities for them to see truth points stuck on someone permanently put them in a dangerous position where should they come acros any medical professional they’ve been misled to repeat what caused the harm to even greater levels.

these people must surely lie to themselves that the harm they are doing isn’t existential and to some they start that horror and take all parts of access to safety or identity at them from such a young age they never get to experience the relief of not being in mortal danger from one idiot just waking up one morning and deciding to take more from them (which this time will they survive and as life is so hard now already, what state will they be in when/if the next attack ever ends)

all this deluded language from such people talking as if they are oblivious to responsibility and seriousness and just play at other peoples lives and safety is sickening

 

There we go I wasn’t off in smelling delusion


Ironically the one thing he has right in this is that proper thinking changes and treatment for cognitive distortions is needed in medicine

it’s interesting he’s picked up on that bit and how ‘off’ thinking is gif this compared to the thinking for other demographics (because let’s be honest it’s about protected characteristics and targeting people with the bps stuff not ‘a belief in an illness’ which is post hoc justification for that ism)

 

The weird thing is that I think some of them seem to believe it - if you’ve met this personality type they are interesting to watch because their conversations are sophism focused on ‘what they want to get/claim’ ie say what you need to win

but then their ‘truth’ becomes what they’ve just said, ie they forget reality or can’t see what’s in front of them as anything other than that rewritten version at all - like they become blind.

these people literally live in ‘reality’ being something that doesn’t really exist as we and others understand it and see it merely as context that can be reframed. I assume it’s some reaction to something , including ego-protection and poor behavioural discipline when younger ie not being pulled up being possible or indeed the need for escapism due to something grim or just cos.

I don’t get how medicine is so vulnerable to this type as a system thing but it’s fascinating

I don’t know why these documents aren’t actually being studied by scientific psychology as case studies of the syndrome/ issue in thinking and yes why some actually can’t see through this because if it was written by the wrong person and changed a few suggestions the same readers would be able to point out each fallacy one by one etc - but just don’t seem to fancy engaging that same brain on mode when the suggestion works for them/is something they like to think / want to agree with

 

I would have liked from an intrigue point if view but these people could be quite dangerous to get embroiled with

scary how many resources such people can often find to draw on