Second-Guessing: Misdiagnoses and Wrong Treatments?

Human beings must learn to accept their imperfection. We should do all we possibly can to avoid errors, but recognize that the limitations of our nature are also the limitations of our duty. Nobody can be expected to do more than his best. I may add that instead of being deterred by the possibility of error, I am rather encouraged by it. If I were certain of knowing the truth, the whole truth, I would not dare to criticize anything, because my judgment would be final and inexorable. (Sarton, 1960, p. 1186)

Second-guessing is a commonplace game in the human enterprise. It has been particularly enshrined within the psychological/clinical helping professions, in which so much of the teaching and the transfer of knowledge, skill, and experience is via the apprenticeship (tutorial) system of supervision, introduced by psychoanalysis, and via the derivative of individual supervision, the clinical case conference. In these settings, the data of the clinical consulting room are conveyed—usually verbally, at times in writing—to the teacher (supervisor) or the case conference participants. The presentation is then supplemented by questions directed toward the presenter (and, quite exceptionally, supplemented by first-hand interview contact with the primary data source, the patient). Comprehensive assessments, judgments, diagnostic formulations, treatment plans, and prognostications are arrived at; these may be long-term or short-term, detailed or general, explicit or at least in part implicit, and so forth. As this process is repeated with the same supervisor and/or conference leader over time, or with different experts independently, and also at varying points in time, there is often a significant degree of reformulating or second-guessing—often with all the benefits of hindsight and of retrospection in the light of unfolding circumstances, as viewed over an extended time frame or from a more productive or objective vantage point.

By the