• Jena Martin MD

Your mindset matters.

Updated: Feb 17, 2019

When is it a long faced man and when is it a woman's nude body from the side?

That question should be asked slightly differently. It's not when is it one or the other, but rather: when do you see a long faced man and when do you see a woman's nude body from the side?

It matters how this question is asked because this drawing demonstrates just how important your mindset, your mental lens, matters. How you interpret the visual world is largely determined by your mind and not your eyes. Your personal viewpoint creates what you see.

The illusion featured above is from an article I read many years ago, one that has occupied a central place in my personal learning of pathology. (Unlike spycraft or pathology, there is no right answer to this image! There will be no test, just self reflection).

In this article from 2006, Dr. McLendon, a neuropathologist, wrote about what can be learned from the cognitive processes of decision-making by studying how CIA analysts process information to make decisions.* For this Mindset illusion, Dr. McLendon highlights how neuropathologists might tend to 'see' a specific cell type over an other (an oligodendrocyte and not just an astrocyte). Just like in pathology, CIA analysts must take in information that is incomplete and ambiguous and make important decisions. To avoid errors, it's important to consider how our cognitive biases effect our interpretations of the world.

This particular illusion of mindset demonstrates that our first impressions are resistant to change. This image is a spectrum of shapes and identities. If I am somehow biased to perceive 'maleness' or 'femaleness', this mental lens may change when/at what image I see one or the other.

How does this relate to the decision making of pathology? Much like what we can encounter in pathology things are not always Black or White. It is also important to consider our mindset when reviewing cases. It How much do our first impressions color our interpretation? I have looked at biopsies from well-known people - how does this cloud my assessment? Or when looking at a biopsy from a child the same age as one of mine - I feel a tug of recognition about the pain behind this tissue. Do I treat the question before me any differently?

To offset this from creeping in, many pathologists prefer to not know anything about the case when first reviewing it. Only after we've examined the slides with what we hope to be a truly open (or full) mind, then we read about the patient's age, gender and background. Other times, perhaps in the frozen section lab for stat evaluation, the opposite is true. It can be important to read thoroughly about the case ahead of time. Brain tumors and breast cancers need to be correlated with imaging studies, which can help a pathologist put on the proper mindset before reviewing the slide.

Let's be honest - a mindset is unavoidable, even hard wired into our cognition.

But we can recognize that once our impression is formed, we need to seek to vigorously examine it. Our approach to problems should seek out definitive and unambiguous evidence to overcome the powerful first impression.

We can compensate for our mental habits with good habits of mental hygiene. Make it a new habit to present to yourself evidence that contradicts your first impression. Question your first instinct. Ask yourself "how might I get this wrong?" and then follow up with specific examples for how that might be the case.

All of our dilemmas can be read different ways - know this, and check yourself and your assessment. After all, if you don't consider a solution to be a possibility, you have made it impossible.

I've looked at several other illusions on this blog, and you can read those posts here:

Dr. McLendon's entire article is here: http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165%282006%29130%5B613%3AEISNAT%5D2.0.CO%3B2