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If superstitions help you get in the zone then keep sharpening those pencils

Ed Smith's "Left Field" column.

A hundred and twenty-one not out overnight, the England batsman Jonathan Trott must have been feeling pretty good about life. There was, however, no room for complacency. When he resumed his innings on the second day of the second Test match in Wellington, New Zealand, Trott went through his full, elaborate series of pre-innings rituals and superstitions. He raked the batting crease with his studs, dragged his bat along the same groove, then raked, then dragged, then raked, then dragged. He then adjusted all the Velcro straps on his batting pads – detaching then attaching, detaching then attaching. Everything was set fair.

Trott then promptly edged his first ball of the day’s play and was caught behind. A colleague in the commentary box was furious. “All that nonsense and then he’s out first ball – surely final proof that it doesn’t work and we won’t see it again!” So who is the more rational man: my commentator colleague or Jonathan Trott?

Trott is certainly in good company. Superstition afflicts – or sustains – many athletes. The unfailingly courteous Rafael Nadal was due to meet the Queen during the 2010 Wimbledon Championships. Nadal had to cancel because he hadn’t met the Queen the day before (when he had won his match). He couldn’t countenance changing a winning pattern. Forced to choose between the Queen and routine, superstition won in straight sets.

Before each innings, the South African batsman Neil McKenzie used adhesive tape to attach his spare cricket bats to the ceiling of the dressing room. He also insisted that the toilet seats were down in the changing room before going out to bat. A crazed madman? No, he is a thoughtful and balanced man.

Trott can even invoke the example of Barack Obama. During his 2008 campaign against Hillary Clinton for the presidential nomination, Obama played an afternoon game of basketball on the day of each primary. Only twice did he skip afternoon basketball. He lost both primaries. Ever since, he hasn’t missed a game on the day of a big vote, even finding time for some hoops on election day last November.

The prospect of performance brings superstition to the surface. After an improved showing in the second debate against Mitt Romney, Obama asked for the same pre-debate menu (steak and potatoes) before the third debate. During the 2008 campaign, Obama’s chief strategist David Axelrod carried a pink quartz heart in his pocket to bring good luck.

Hedge-fund managers argue that they have found rational ways to beat the market while still clinging to lucky charms. In 1987, the investor Paul Tudor Jones allowed PBS to make Trader, a documentary about his methods. Before one trade, Jones laces up a special pair of trainers, explaining to the camera: “These tennis shoes are what the future of this country hangs on because they’ve been good for a point rally in bonds and a 30-point rally in stocks every time I put them on . . . I bought them at a charity auction. They’re Bruce Willis’s, the man’s a stud.” Jones was not proud of his superstitious confessions in Trader. He has tried to buy every VHS copy ever produced and still fights to have all clips removed from internet sites.

What is going on here, how can these apparent contradictions be reconciled? Obama’s strategists have taken electoral science to new levels of accuracy. In the history of elections, no campaign has pursued votes with more money or statistical rigour, and yet they cannot shake quartz hearts and basketball rituals.

The psychologist B F Skinner placed some hungry pigeons in a cage and fed them at random intervals. The pigeons linked the first arrival of food with the actions they were performing at the time. To the pigeons, this “link” remained fixed, even though it failed to influence the arrival of food in the future. So Skinner noted that one bird “repeatedly thrust its head into one of the upper corners of the cage”, while another “developed a ‘tossing’ response, as if placing its head beneath an invisible bar and lifting it repeatedly”. On one level, superstitious humans are stooping to the same level as Skinner’s pigeons. An action is (initially) followed by a desired outcome. Then follows the logical jump that the action had caused the outcome, when in fact there was no causal relationship at all.

When it comes to differentiating between randomness and causality, surely we ought to do better than a bunch of pigeons? And yet I’ve been superstitious all my life. My preball routine in the batting crease was almost as contorted as Trott’s. After the third ball of every six-ball over, I would ask the umpire how many balls were left in the over. I usually knew the answer but I asked anyway. I batted for as many as 15,000 overs in my career, so I must have asked the umpire whether there were three balls left about 15,000 times.

I used to blame my superstitions on abject irrationality. I wanted to be cured. One season I tried to go cold turkey. But after a few failures, I fell off the wagon; it was back to asking, “Three more?”

Now I am not so critical. The line between routine and superstition is very blurred. Routine is an essential part of getting into the zone. My father is a writer. His day begins with the ritual sharpening of a dozen 3B pencils; he refuses to write with anything else. The pencil sharpening, I expect, is one of the ways he signals to himself that he is entering a different psychological zone. That is what Trott is doing, too. And it works, at least often enough for him to be one of the best batsmen around. Apparent irrationality can be surprisingly rational.

Be careful before you examine too carefully the foundations of your confidence. Self-belief relies on an array of misappraisals of the causes of your own success.

Ed Smith is a journalist and author, most recently of Luck. He is a former professional cricketer and played for both Middlesex and England.

This article first appeared in the 25 March 2013 issue of the New Statesman, After God

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide