Medicine and heuristics: cognitive biases and medical decision-making
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REVIEW ARTICLE
Medicine and heuristics: cognitive biases and medical decision-making Dale F. Whelehan 1 & Kevin C. Conlon 1 & Paul F. Ridgway 1 Received: 16 March 2020 / Accepted: 16 April 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Introduction Clinical decision-making is a daily practice conducted by medical practitioners, yet the processes surrounding it are poorly understood. The influence of ‘shortcuts’ in clinical decision-making, known as heuristics, remains unknown. This paper explores heuristics and the valuable role they play in medical practice, as well as offering potential solutions to minimize the risk of incorrect decision-making. Method The quasi-systematic review was conducted according to modified PRISMA guidelines utilizing the electronic databases Medline, Embase and Cinahl. All English language papers including bias and the medical profession were included. Papers with evidence from other healthcare professions were included if medical practitioners were in the study sample. Discussion The most common decisional shortcuts used in medicine are the Availability, Anchoring and Confirmatory heuristics. The Representativeness, Overconfidence and Bandwagon effects are also prevalent in medical practice. Heuristics are mostly positive but can also result in negative consequences if not utilized appropriately. Factors such as personality and level of experience may influence a doctor’s use of heuristics. Heuristics are influenced by the context and conditions in which they are performed. Mitigating strategies such as reflective practice and technology may reduce the likelihood of inappropriate use. Conclusion It remains unknown if heuristics are primarily positive or negative for clinical decision-making. Future efforts should assess heuristics in real-time and controlled trials should be applied to assess the potential impact of mitigating factors in reducing the negative impact of heuristics and optimizing their efficiency for positive outcomes. Keywords Cognitive biases . Decision-making . Diagnostics . Medical error
Introduction
What this paper adds This paper provides the reader with an overview of some of the most commonly used heuristics in medical practice. It discusses how best to use them in order to maximize positive patient outcomes. It also highlights some potential interventions to mitigate the risk of negative impacts when using them. This ‘toolkit’ will assist in increasing awareness of clinical decision-making models utilized by medical practitioners. * Dale F. Whelehan [email protected] 1
Discipline of Surgery, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
Medicine is a science of uncertainty and an art of probability.—William Osler Doctors make decisions daily which impact on the lives and livelihood of others. Decision-making is either fast, intuitive, heuristic-like and influenced by our cognitive biases, or analytical, thoroughly assessed and well-reasoned [1]. Heuristics are decisional shortcuts, influenced by our own cognitive biases, and are use
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