Do orthopaedic surgeons acknowledge uncertainty?

Clinical Orthopaedics and Related Research, 2016

This study examined whether uncertainty intolerance influences surgical decision-making in clinical orthopedics. We found that surgeons vary significantly in their tolerance for ambiguity, and that this variation affects treatment recommendations.

Journal of the American Academy of Orthopaedic Surgeons, 2021

Cognitive biases are ubiquitous in human reasoning, and orthopedic decision-making is no exception. This study evaluated the prevalence of specific biases—including anchoring, availability, and framing effects—among academic orthopedic surgeons.

JBJS (accepted for publication 3/2026)

Every clinical encounter is dense with unacknowledged philosophical commitments—about knowledge, causation, probability, and value. This project identifies and maps five core philosophical concepts embedded in routine orthopaedic practice, arguing that making these frameworks explicit improves clinical reasoning, informed consent, and the quality of decisions made under uncertainty..

PLOS ONE (revision submitted 3/2026)

 Bayesian probability is notoriously difficult to apply in clinical settings, yet it remains unclear how often surgeons actually use Bayesian reasoning in practice. This study quantified the prevalence of base rate neglect and other non-Bayesian patterns in clinical decision-making vignettes.

JBJS (submitted 3/2026)

Abstracts and discussion sections of the same paper are not epistemically equivalent—yet readers and AI systems treat them as if they are. In a corpus analysis of 201 publications from JBJS and CORR, this project quantifies the divergence between the confident language of abstracts and the hedged, qualified language of full-text discussions. The gap is systematic, measurable, and has direct consequences for how evidence is interpreted, synthesized, and consumed by large language models trained on abstract-heavy data.

CORR (submitted 4/2026)

When estimating probabilities for an individual patient, surgeons must decide which reference class to draw from—but this choice is rarely straightforward and often formally intractable. Building on work by Reichenbach and Hájek, this project explores how expert clinicians navigate the reference class problem in practice.

Interactive model link here.

JOT (in progress... 4/2026)

For over two decades, orthopaedic surgeons have failed to agree on what fracture union means. This project argues the impasse is not a coordination problem but a category error: union is a clinical judgment imposed on a continuous biological process, not a biological state awaiting discovery. Ernst Mayr called this habit of imposing fixed types on continuous variation "the dead hand of Plato" — and the fracture healing literature is a textbook case. A corpus analysis of 300 research articles reveals that 93% of papers define union as a decision — then report it as a biological fact. The judge disappears. What remains is a literature that mistakes its own conventions for nature.

(Future project...)

Fracture healing is a continuous biological process, yet orthopedic research routinely forces it into categorical endpoints—healed or not healed, union or nonunion. This project examines the epistemological problems that arise when continuous phenomena are compressed into binary classifications, and how this mismatch affects the validity of clinical research and treatment decisions.

Future project...

High-frequency experience sampling captures what traditional outcomes research misses: the pathway of recovery, not just the destination. By querying patients daily with a single-item functional score, we construct continuous recovery curves that reveal improvement velocity, total disability burden, and the moment healing stabilizes. 

The determination of when a fracture transitions from "not healed" to "healed" is inherently imprecise—yet it is routinely treated as binary in both research and clinical practice. This project examines how surgeons navigate this vagueness and whether the Sorites paradox (which arises when sharp boundaries are applied to vague predicates) is recognized or tolerated in orthopedic decision-making.