Assumptions kill - your life, career and well-being.

In an operating room - assumptions kill. Assumptions also derail your everyday life, career, and relationships. Often even without you realising that your decisions are based on false premises.

One of the greatest risks to patients’ safety comes from surgeons’ assumptions. Similarly, the greatest risk to your well-being, career progression or quality of your relationships comes from yourself.

Why?

Because of our default, natural cognitive response to any situation: assumption. The most critical part of thinking like a surgeon is to quickly spot your assumptions and replace them with assessments.

What is an assumption?

It is a previously acquired (learned) belief that is accepted by an individual as truth without any proof or evidence.

Assumptions are formed in normal cognitive processes that help individuals to make rapid decisions. The problem is that most assumptions are either incorrect, outdated or irrational. It is even possible for human brains to automatically create assumptions without us even realising how they will influence our thinking.

Remember - assumptions are always subjective, we are not always consciously aware of them, and they are rarely based on objective facts!

Surgeons know that human brains are subjective by design, and driven by assumptions derived from previous experiences. We know they are unreliable. We know that assumptions kill.

Our thoughts and assumptions strongly shape how we perceive and experience any situation. Every person has a different viewpoint and a different frame of reference. This is why different people differently interpret the same situation, often making new assumptions about an event or a person in the process.

This is why when people rely on assumptions, they tend to reject objective reality, overlook facts, and succumb to their personal biases. Unfortunately, this is our default thinking mode, and it takes conscious effort and training to correct it.

In order to change this undesired mode of operating, we need to replace assumptions with assessments.

What is an assessment?

Assessment is a method of creating a fact-based, true and objective view of any situation or person based on most accurate, and most recently collected information.

The principle is that any current, factual information outweighs any previously held, emotionally acquired belief. Assumptions stay the same. Assessments are based on current facts and are therefore subject to constant change; assessments are updated as new evidence becomes available.

This requires a degree of mental agility and flexibility to be able to change your views based on newly acquired information, often recognising and reconciling cognitive dissonance by changing your views.

Assessments are changed and updated as needed. They can also be agreed upon by other individuals observing the same facts - as they are not rooted in individuals’ past experiences, beliefs or backgrounds.

Example:

A patient arrives in the emergency room with severe abdominal pain. An attending physician states the cause is acute appendicitis. His diagnosis is based on the typical, textbook presentation of the symptoms , and influenced by his past experiences, which demonstrates that the symptoms the patient is describing are usually attributed to acute appendicitis. Because acute appendicitis is a medical emergency, the surgeon decides to proceed directly to an appendectomy, relying on his clinical judgment.

If his assumption is incorrect, the patient might have a different condition, such as an ectopic pregnancy, intestinal obstruction, or another non-appendiceal issue that requires a different treatment approach. This could lead to unnecessary surgery, delayed appropriate treatment, and increased risk of complications or mortality.

That is why doctors are trained to assess, not assume. To help doctors recognise assumptions, their initial idea (assumption) is called a “working diagnosis”. At each step in the diagnostic process, all assumptions should be validated by appropriate tests and/or consultations, and the working diagnosis should be updated every time a new piece of information becomes available.

In this particular case, the patient was undergoing an atypical presentation of a heart attack, and proceeding with abdominal surgery would most likely be fatal.

Here is a short summary from a medical setting comparing assumptions and assessments. It can be easily understood and adapted for any other context:

Notice the timing element. Assumptions are typically based on something that happened in the past, while assessment relies on most recent information. Assessments are deliberate, while assumptions are often automatic (or even not consciously realised).

Precision matters

Surgeons must be precise. Not only in their manual skills but also in how they communicate. Operationalising any textbook knowledge requires precision; this includes being precise in your speech and use of words.

Word precision allows us to communicate without misinterpretations. Be clear and precise when describing your thoughts and thinking processes. Differentiate between assumptions and assessments. Learn to separate subjective and objective information and leverage both to make informed, accurate decisions.