2b) Clinical Decision Making

Question 1

Clinical decision making:

Confirmatory bias (explanation)
The sunk cost fallacy (explanation)
Heuristics (specifically Availability and Representativeness heuristics) Strategies for improving clinical decision making

Answer 1

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Question 2

Define Medical error

Answer 2

An error is defined as the failure of a planned action to be completed as intended (i.e., error of execution) or the use of a wrong plan to achieve an aim (i.e., error of planning).

Question 3

What is meant by confirmatory bias?

Answer 3

tendency to search for or seek, interpret, and recall information in a way that confirms one’s preexisting beliefs or hypotheses, often leading to errors

e.g always reading fake news + relying on it
to justify your decisions on top of it
e.g if patient reveals family history –> causes clinicians to link symptoms with family history

Question 4

What is Sunk Cost Fallacy ?

Answer 4

• amount of cost invested in something influences future course of action
• e.g “ive waited for the bust for 15 mins i can’t leave now:
• the more invested in the past, the more we are prepared to invest in problem in the future

Question 5

What is meant by anchoring effect?

Answer 5

e.g was $100, now $70

individuals are poor at adjusting estimates from a given starting point
- anchored by a starting point

Question 6

What is Representativeness heuristic?

Answer 6

subjective probability that an individual belongs to a particular class based on how typical that class appears to be

e.g person with glasses might be predicted to be in a smarter class group

Question 7

What is Availability heuristic?

Answer 7

probabilities are estimated on basis of how easily / vividly they can be called to mind

• people tend to heavily weigh their judgements towards more recent information
  e. g 80% people think traffic accidents cause more deaths than stroke –> more news coverage,

Question 8

what are the 5 ways to improve decision making?

give details for each

Answer 8

1) Education and Training
- recognise that heuritiscs/ biases may affect judgement
- educate about cognitive/ diagnostic error

2) Feedback
- increase no. of autopsies
- improve feedback by others

3) Accountability
- increases send of accountability

4) Generating alternatives
- establish consideration of alternative possibilities

5) Consultation
- seek 2nd opinions
- algorithms
- clinical decision making support systems

Question 9

what are the main causes of medical errors?

Answer 9

• cognitive errors

Question 10

note:
heuristics = important for quick clinical decision making –> involves pattern recognition + relies on subconscious integration of data

Answer 10

e.g important in A&E setting

Question 11

define algorithms

Answer 11

• procedure which if followed increases the chance of making the correct decision / choice

(difficult in hospitals –> due to comorbidities)