The Impact of Mental Models on Diagnostic Bias in Physiotherapy

10 The Impact of Mental Models on Diagnostic Bias in Physiotherapy

“If you go into a conversation expecting it to be contentious, that mental model can ensure that you selectively focus on the aspects of the interaction that reinforces that story, and dim down competing information that might have offered a better way forward.

Dr. Amishi Jdu “Peak Mind


The quote above is extremely thought provoking with respect to possible upcoming contentious conversations. But what happens when you substitute ‘contentious’ with ‘a certain diagnosis’? 

In the field of physiotherapy, accurate diagnoses are crucial for providing effective treatment and care to patients. However, biases can sometimes cloud the judgment of healthcare practitioners, including physiotherapists, leading to incorrect or incomplete diagnoses. One influential factor in this process is the concept of mental models. In this article, I will explore how mental models can impact the diagnostic process in physiotherapy and discuss strategies to mitigate their potential biases.

The Influence of Mental Models on Diagnostic Bias:

Mental models are preconceived notions or frameworks that individuals hold, shaped by their experiences, beliefs, and expectations. This includes where they were trained and who taught them.

When physiotherapists approach an assessment or conversation with a patient, their mental models can significantly shape their perception and decision-making.

Imagine a physiotherapist who enters a session expecting a certain diagnosis based on a letter of referral from another healthcare provider or an X-Ray report. This mental model can subtly bias their focus, causing them to selectively emphasise information that supports their preconceived notion while downplaying contradictory evidence. As a result, they may miss important clinical findings that could lead to a more accurate diagnosis.

Communication Dynamics and Diagnostic Bias:

Mental models can also impact the communication dynamics between physiotherapists and their patients. When a physiotherapist holds a strong expectation of a particular diagnosis, it can inadvertently influence their non-verbal cues and communication style. They may unknowingly display confirmation-seeking behaviours, which can limit the patient’s input and hinder the exchange of crucial information. Consequently, this can contribute to a misdiagnosis or an incomplete understanding of the patient’s condition.

Mitigating Diagnostic Bias:

To minimise diagnostic bias in physiotherapy, awareness and active management of mental models are essential. Physiotherapists should strive to cultivate an open-minded approach and consciously challenge their preconceived notions. By actively seeking out information that contradicts their initial assumptions, they can broaden their perspective and reduce the risk of biased decision-making.

Empathy and effective communication skills play vital roles in mitigating biases. Physiotherapists should create a supportive and non-judgmental environment, where patients feel comfortable sharing their experiences and concerns. Active listening and genuine empathy help build trust and encourage patients to provide accurate information, contributing to more accurate diagnoses.


Mental models can significantly impact the diagnostic process in physiotherapy. Physiotherapists must recognise the influence of their mental frameworks and actively work to minimise bias. By adopting an open-minded approach, actively challenging preconceived notions, and emphasising empathetic communication, physiotherapists can enhance the accuracy of their diagnoses, leading to more effective treatment and improved patient outcomes.

10 Tips to Minimise the Impact of Mental Models on Bias

  1.  Foster Awareness: The first step in combating bias related to mental models is to develop self-awareness. Recognise that everyone has mental models and that they can influence your decision-making process.
  2.  Embrace Open-Mindedness: Cultivate an open-minded approach by actively seeking out alternative perspectives and information that challenges your preconceived notions. Be willing to consider different possibilities and interpretations.
  3.  Challenge Assumptions: Question your assumptions and expectations about a situation or diagnosis. Ask yourself if there are any alternative explanations or factors that you may have overlooked.
  4.  Seek Diverse Perspectives: Engage in discussions and collaborate with colleagues or professionals from different backgrounds and experiences. This exposure to diverse perspectives can help broaden your mental models and reduce bias.
  5.  Practice Reflective Thinking: Set aside time for self-reflection on your diagnostic decisions. Analyse the reasoning process you followed and consider whether any biases influenced your conclusions.
  6.  Continual Education: Stay updated with the latest research, evidence, and best practices in your field. Expanding your knowledge base can help challenge outdated mental models and ensure your diagnoses are based on the most current information.
  7.  Encourage Patient-Centered Care: Prioritise patient-centered care by actively involving patients in the diagnostic process. Listen attentively to their concerns, ask open-ended questions, and validate their experiences. This approach can help counteract biases and improve diagnostic accuracy.
  8.  Build Effective Communication Skills: Develop strong communication skills, including active listening and effective questioning techniques. Encourage patients to share their complete medical history and ensure they feel comfortable expressing their symptoms and concerns.
  9.  Create a Supportive Environment: Foster a non-judgmental and supportive environment that encourages open dialogue between healthcare professionals and patients. Patients should feel comfortable expressing their thoughts and experiences without fear of judgment or bias.
  10.  Regularly Evaluate and Reflect: Routinely assess your diagnostic practices and outcomes. Analyse cases where bias may have influenced your decisions and use them as learning opportunities. Reflecting on your experiences can help identify patterns of bias and guide you towards more objective diagnoses.

By implementing these strategies, healthcare professionals, including physiotherapists, can minimise the impact of mental models on bias. Through awareness, open-mindedness, and ongoing self-reflection, practitioners can improve their diagnostic accuracy and provide optimal care to their patients.

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