Black, Indigenous and People of Colour, Larger Bodies and Eating Disorder Recovery 5
Thin Slicing
Practitioners look at the patient and make very fast judgment calls using thin slicing. I’ve mentioned Robert Rosenthal in other material on this site. He passed away last year. I reference his work on the experimenter effect—when researchers inadvertently sway the results of a study by influencing the subjects (with both parties utterly unaware they are doing so). [1] Drs. Nalini Ambady and Robert Rosenthal also coined the term “thin slicing.” [2] Thin slices of expressive behaviour (thin-slicing) allows for all human beings to make fairly accurate predictions about a person on a variety of attributes from personality, to socioeconomic and educational background, internal state, relationship status, sexual preference and even future behaviours.
“The effect size of .39 for the overall accuracy of prediction from observations of less than 5 min is higher than most of the effect sizes found in social and personality psychology (Cohen, 1988). An r of .39 with the criterion, according to Rosenthal and Rubin’s binomial effect-size display, means that correct classifications can be made using thin slices of behavior nearly 70% of the time, compared with about 30% of the time when no thin slices are available (Rosenthal & Rubin, 1982).”
We are also equally accurate thin slicing with or without the person speaking and we maintain that high degree of accuracy down to ½ a minute of exposure to the other person. In fact, our accuracy does not improve with more exposure than a ½ minute.
As I was working through the background research on this subtopic, I came across this paper: Thin slicing our way to self-protection: Stereotypical reality and the perception of criminal type. [4] The authors are trying to tease apart the fact that thin slicing is an accurate tool used by humans but it becomes “controversial and caustic when we start to consider the application, implication, and utility in context.…perceptual judgements about self-protection resulting in false-positives result in no personal harm to the perceiver but contribute to broader social harms by perpetuating erroneous conclusions, whereas perception based determinations resulting in false-negatives result in great personal harm to the misperceiver but limited social harm.” [5]
In other words, assuming someone is a threat when they are not leads to more ingrained societal levels of discrimination, but assuming someone is not a threat when they are leads to harm for the lone individual making that assumption, but does not reinforce society-wide discrimination.
Thin slicing relies on implicit biases and the likely evolutionary benefit is self-protection. Therein lies the problem in both the research and clinical work on this topic: diagnosis and treatment are not best-served using a tool designed for self-protection. It’s also unclear in a clinical setting whether the accuracy of predictions is the result of experimenter effect as opposed to thin slicing.
If we were serious about discrimination in clinical settings, we would train our practitioners to be able to superimpose a thick layer of protocol and discipline to their natural proclivity (because they are human) to thin slice. The power differential in a clinical setting may not completely eradicate the need for self-protection (for the practitioner), but the obligation of the practitioner is to provide care to the patient. If a practitioner relies exclusively upon thin slicing to choose a path of diagnostic investigation, then they have, at best, an accuracy of 70%. That’s statistically relevant, but if you had a 30% chance of a surgeon removing the wrong organ during surgery, you’d instantly identify that the surgeon’s methods are highly questionable.
What to Look For and Options
I once had a new-to-me dental hygienist. My dentist always hires exceptional people, but this hygienist stood out even more than usual. She got me settled in the chair with the bib, arranged her tools a bit and then wheeled her chair around to my side before lowering my chair to its reclined position.
She slowed right down. Introduced herself, complimented me on my earrings and then asked how my day was going so far. That’s nothing too exceptional right? But it was the way she did it. She really looked at me and was so present and focused on me. She let there be pauses after I finished answering the question. She then asked if there were any concerns that I had. Again, pausing and slowing down to really hear the answer and to let me carry on with further details if I had them to give.
One of the things that the Yay Science! crowd don’t recognize is that the attention and focus many patients receive in alternative care settings are actually not that difficult to implement in standard modern medical practice. It’s not merely a function of the fact that many alternative practitioners have much longer appointments with patients.
As a patient, you want to be seen and heard. You are looking for a practitioner, even one very pressed for time, to actually pause long enough to see you and hear you before beginning any procedures or hands-on investigations. Honestly, it needs mere seconds. If you never see the practitioner pull their eyes away from the screen, breathe, sit down or give any signal that counters them itching to move on to the next thing, then you can generate a pause yourself. When they ask their first question, resist the urge to respond immediately and remain silent long enough that the pause will do two things: pulls them to actually look at you, and is a long enough pause that it’s a bit socially uncomfortable. Sometimes, instead of answering the question I might even say: “How’s it going for you today?” —but not in a sarcastic or accusing way!
We tend to enter examination rooms and are guilty of not registering the practitioner before us as much as they don’t register us. Everything is designed for both parties to treat the exchange as a time-squeezed transaction. Do you remember the last time you asked how the practitioner entering the room was doing today?
You thin slice and they thin slice, and that’s designed for self-protection and not for connection. Do we need to connect with each other in these healthcare settings? For best outcomes, ideally, yes.
First of all, thin slicing for you is very important because the power differential in any interface with a healthcare practitioner means that using this tool is warranted. But within that first half a minute you also want to ask yourself internally what that thin slice is actually telling you.
“What exactly have I picked up on here? Do I have a good/bad vibe or neutral?” It’s okay if you can’t identify exactly what you’ve picked up on, but you can likely categorize it into a good/bad or neutral overall sense of the person. Making that judgment conscious will help you to choose to divulge your concerns, or not, in that first interaction.
If there’s a negative sense you’re picking up on, that doesn’t automatically mean that the appointment will be a disaster. It does likely mean you will be more reserved and perhaps choose not to broach the topic of the eating anxieties you are dealing with at all. That’s okay.
In all but a full blown medical or psychiatric emergency, you have options. It can help to remind yourself of that. If you’ve had a lot of bad experiences with healthcare professionals, it often changes the energy in the room to be someone who respectfully treats healthcare professionals as the advisers that they are, rather than as individuals who hold ultimate decision-making control. Internalized stigma and discrimination can predispose you to the experimenter effect. Experimenter effects happen beyond the world of clinical trials. It is also known as interpersonal expectancy effect. In other words, a carelessly fattist and/or racist provider can readily activate your own internalized schemas (frameworks) of seeing yourself in that light and acting according to those biases. Awareness is the best deflection shield you have.
If you tend not to feel safe in these environments, then bring someone with you to the appointment if you can. It need not be someone who agrees with you and your medical mind [referencing a book I recommend on uncovering how you prefer to interface with medical practitioners], but rather someone who has an overabundance of confidence and has a tendency to rabidly (in an upbeat way) defend you and support you. While awareness is a shield, it’s confidence that is the tool that changes all the energy in the room. If you are not confident, and cannot fake confidence, then bring someone with you who epitomizes confidence.
Getting back to the specific diagnostic tools in the next installment on July 4,
Image in Synopsis: Hazem Elsheltawi
https://gwern.net/doc/statistics/bias/1976-rosenthal-experimenterexpectancyeffects.pdf
Ambady N, Rosenthal R. Thin slices of expressive behavior as predictors of interpersonal consequences: A meta-analysis. Psychological bulletin. 1992 Mar;111(2):256.
ibid.
Krienert JL, Walsh JA, Acquaviva BL. Thin slicing our way to self protection: Stereotypical reality and the perception of criminal type. Applied Psychology in Criminal Justice. 2018 Jan 1;14(2):120-35.
ibid.
