2b: Clinical decision making Flashcards
What is Kahneman’s 2 systems for decision making?
“HOT” System: Acting quickly
Fast, simple, emotional, reflexive, increased by stress
“COLD” System: Acting thoughtfully
Slow, complex, cognitive, reflective, worsened by stress
Define Confirmation Bias
The tendency to seek, interpret and recall info in a way that confirms one’s pre-existing beliefs or hypotheses.
Often leads to errors.
Hence always look/test for alternative to diagnosis
Define Sunk Cost fallacy
Sunk costs = Any costs spent on a project that are irretrievable (e.g. expensive drugs)
Sunk Cost fallacy = the greater the sunk costs, the more we are prepared to invest in a problem in the future - even though rationally, the only factor affecting future decision should be FUTURE cost/benefit ratio
What is availability heuristics?
Probabilities are (over)estimated on the basis of how easily and/or vividly they can be called to mind.
Availability errors:
- People overestimate the frequency of dramatic, catastrophic events (e.g. car crashes)
- Overestimation due to previous experience (e.g. doctor that missed a rare diagnosis might overestimate its risk in future patients even though it’s rare)
- People overestimate based on recent information MORE than older information
What is representativeness heuristics?
SUBJECTIVE probability that something belongs to a particular class based on how typically it appears in that class
What are 5 strategies in improving clinical decision making?
- Education + training = Teach how to recognise bias and avoid cognitive/diagnostic errors
- Feedback = Follow-up patients, conduct regular systematic audits
- Accountability = Establish clear accountability/follow-up for decisions made
- Generating alternatives = Force consideration of alternative possibilities, encourages questions
- Consultations = Seek second opinions, clinical decision-making support teams
