A pandemic of cognitive bias
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FROM THE INSIDE
A pandemic of cognitive bias Francesco Landucci1* and Massimo Lamperti2 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
The Sars-CoV-2 pandemic is an unprecedented challenge to today’s clinicians: the urgent need to act, the lack of time to collect robust evidence and the collective fear of failure have created ideal conditions for cognitive biases to flourish. A cognitive bias is a systematic pattern of deviation from an established norm or rationality in judgment [1]. Individuals create their own “subjective reality” from their perception of the input. As a result, individuals’ construction of reality may guide their behavior in the world. Although some cognitive biases can be adaptive since they may lead to more effective actions in a given context, especially when timeliness is more valuable than accuracy, they may also lead to perceptual distortion, inaccurate judgment and illogical decisions as they result from our limited capacity for information processing. The current pandemic has given us many examples of cognitive biases. Hoarding food and toilet paper despite official assurances of sufficient and stable supply are examples of impaired decision-making: stressed people often believe that taking action, any action, no matter the kind, tends to resolve problems, a phenomenon known as action bias. Such a bias will naturally be amplified in a social context because of the human tendency to follow blindly the actions of the others (the “bandwagon effect”) out of fear of missing out on something [2]. Unfortunately, queuing in front of a supermarket can only create dangerous vicious circles by spreading infection and panic. The same happened with the use of hydroxychloroquine leading to misleading and harmful consequences [3].
*Correspondence: [email protected] 1 Anaesthesia and Intensive Care Department, San Giovanni Di Dio Hospital, Via di Torregalli 3, 50143 Florence, Italy Full author information is available at the end of the article
Cognitive biases have been responsible for flawed narratives around key parts of our health system. For example, the notion that coronavirus disease 2019 (COVID-19) mortality rates are strictly dependent on the availability of ventilators has enabled a focus on one objective element of the system. However, this has come at the expense of forgetting that the patients on mechanical ventilation need a comprehensive healthcare support system, with a range of other equipment as well as suitably trained manpower and ventilators are a minimal part in the system. This is an example of what is called substitution bias, where, faced with a complex and difficult question (how to make sure the healthcare system is capable of delivering that support), an easier one (how to increase the supply of ventilators) is substituted. While intensivists may find it ridiculous to focus only on available ventilators, they have not been immune from cognitive bias. Notably, we lacked suitable definitions of what we were facing and have merely used the labels we
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