2b: Clinical decision making Flashcards
Define medical error
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).
What are the main causes of medical errors
Both system-related and cognitive factors
Cognitive error
What is heuristics
Heuristics are often referred to as rules of thumb, educated guesses, or mental shortcuts
What do heuristics involve
pattern recognition
rely on a subconscious integration of patient data with prior experience
Outline Kahneman’s 2 systems for decision making
Hot- emoitonal, go, simple, reflex, fast, accentuated by stress, stimulus controls
Cold- cognitive, know, complex, reflective, attenuated by stress, self control
What did nesbitt and wilson show
System 1 (Hot) often controls our actions automatically but system 2 (Cold) is blissfully unaware, believing itself to be in charge!
What is confirmatory bias
The tendency to seek, interpret, and recall information in a way that confirms one’s preexisting beliefs or hypotheses, often leading to errors
BE SURE TO TEST ALTERNATIVES
What are sunk costs
Sunk costs are any costs that have been spent on a project that are irretrievable ranging including anything from money spent building a house to expensive drugs used to treat a patient with a rare disease.
What is the sunk cost fallacy
Rationally the only factor affecting future action should be the FUTURE costs/benefit ratio but humans do not always act rationally and often:
SCF: the more we have invested in the past the more we are prepared to invest in a problem in the future, this is known as the Sunk Cost Fallacy
(i.e fruit machines)
What is anchoring
Individuals poor at adjusting estimates from a given starting point (probs. & values)…. i.e. if a patient says they have family history of migraines, you’re just going to think it’s that
Adjustments crude & imprecise
Anchored by starting point,
Think, in sales 100£ down to 70£ for jeans (but they only cost £2.50 to make and one can forget this)
NEED: What is representativeness heuristic
clue… relates to probability
Subjective probability that a stimulus belongs to a particular class based on how ‘typical’ of that class it appears to be (regardless of base rate probability)
i.e. quiet neighbout statistically more likely to be police office rthan librarian
Downfalls of representativeness heuristic
While often very useful in everyday life, it can also result in neglect of relevant base rates and other errors.
Relationship between framing and age
When presented with treatment descriptions described in positive, negative, or neutral terms, older adults are significantly more likely to agree to a treatment when it is positively described than they are to agree to the same treatment when it is described neutrally or negatively
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NEED: What is the avaiability heuristic
clue: kings and probability
Probabilities are estimated on the basis of how easily and/or vividly they can be called to mind.
People tend to heavily weigh their judgments toward more recent information
Individuals typically overestimate the frequency of occurrence of catastrophic, dramatic events
What is availability errors
clinician who recently missed the diagnosis of pulmonary embolism in a healthy young woman who had vague chest discomfort but no other findings or apparent risk factors might then overestimate the risk in similar patients and become more likely to do chest CT angiography for similar patients despite the very small probability of disease.
