The Superstition Hack
A friend was visiting in the home of Nobel Prize winner Niels Bohr, the famous atomic scientist. As they were talking, the friend kept glancing at a horseshoe hanging over the door. Finally, unable to contain his curiosity any longer, he demanded: “Niels, it can’t possibly be that you, a brilliant scientist, believe that foolish horseshoe superstition?” “Of course not,” replied the scientist, “But I understand it’s lucky whether you believe in it or not.” (unverified anecdote)
While spending a night on call with a third-year neurosurgical resident, I was dropped off in the operating room of Reid Thompson, MD, FAANS, a neurosurgeon at Vanderbilt University Medical Center. Against the backdrop of the cold and sterile operating theatre he radiated warmth and infectious positivity. As if determined to personally dispel every surgery-related stereotype, Dr. Thompson is kind, humble and incurably superstitious.
According to Residency Program Director Lola Chambless, MD, FAANS, Dr. Thompson’s charming portfolio of superstitions includes:
- Bone flaps cannot have 13 screws.
- No one can say these words: “die, dead, blind, deaf, kill.” And absolutely NEVER say “adipsic DI.” It happened once in 2007 and we are all still reeling.
- Music must be on at all times, but music that includes any of the above words must be skipped IMMEDIATELY.
- Anyone who does something potentially ill-fated must turn in three circles.
Of course, it is fun to make sport of the idiosyncrasies of an accomplished surgeon, but it was Dr. Chambless’s final statement that caught my attention: “… his results are great, so maybe there is something to it.”
Humor or Contempt?
Most discussions of superstition in the medical community travel along one of two well-worn tracks. One is to meet superstitious ideas with contempt. An understandable impulse, since some superstitious ideas have been found to be harmful. Pathological superstitions include anti-vaccine sentiments, homeopathy, ‘natural’ cancer cures and many others. The other response to superstition is more lighthearted, exemplified by my own reaction to the superstitions of Dr. Thompson – an amused chuckle.
The discussion lacking is one born of curiosity. Superstitions are not rare in medicine. Pre-surgery rituals and lucky scrub caps are among the most common manifestations in surgery, so prevalent, in fact, that they probably do not even register to most as superstitions. Once we recognize our own superstitious behavior, an important question emerges: Why would otherwise rational people, neurosurgeons, maintain patently irrational practices?
The work of Lysann Damisch, a psychologist at the University of Cologne in Germany, suggests an answer. In a series of experiments published in the journal Psychological Science, she tested the idea that good luck-related superstitions (lucky charms, good luck messages) improve performance. This was true for tasks involving motor dexterity and cognitive tasks alike. Dr. Damisch also shows that activated superstitions increased confidence, expectations for performance and perseverance during the task. All of these are traits associated with good neurosurgeons.
Already, I can hear the objection that endorsing superstitious thinking violates the ideal of evidence-based medicine, a soft embrace of irrationality. But, there is a useful analog to offer. Recent research suggests the placebo effect works even when you are aware of it. We can obtain the benefit of a quirk in our psychology without fooling ourselves or sacrificing scientific rigor. Similarly, with superstitious practices, we can reap the rewards without actually believing any nonsense.
If activated, superstitions can improve performance on cognitive and motor tasks, and having rituals can improve confidence and perseverance. Should surgeons not be encouraged to have them?
The stakes in neurosurgery are high, even marginal gains over time equal lives saved and suffering reduced.
1. Damisch, L., Stoberock, B., & Mussweiler, T. (2010). Keep Your Fingers Crossed! Psychological Science, 21(7), 1014–1020. doi: 10.1177/0956797610372631
2. Kaptchuk, T. J., Friedlander, E., Kelley, J. M., Sanchez, M. N., Kokkotou, E., Singer, J. P., … Lembo, A. J. (2010). Placebos without Deception: A Randomized Controlled Trial in Irritable Bowel Syndrome. PLoS ONE, 5(12). doi: 10.1371/journal.pone.0015591
Kranzler Chicago Review Course in Neurosurgery
Jan. 24-31, 2020; Chicago
46th Annual Richard Lende Winter Neurosurgery Conference
Jan. 31-Feb. 3, 2020; Snowbird, Utah
Third Annual Cedars Sinai Intracranial Hypotension Symposium
Feb. 8, 2020; Los Angeles
2020 Managing Coding and Reimbursement Challenges
Feb. 14-16, 2020; Las Vegas
13th Annual International Symposium on Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery
Feb. 21-23, 2020; Lake Buena Vista, Fla.