4. Clinical decision making Flashcards
What is an error?
Failure of a planned action to be completed as intended, or the use of a wrong plan to achieve an aim
Give an example of an experiment highlighting an issue with the nurse-doctor relationship?
- Researchers placed a fictional drug with a label clearly stating “Max dose 10mg”
- ‘Dr Smith’ rang the ward an asked a nurse to administer 20mg, and he would sign for it later
- 21/22 nurses prepared the dose
Are errors more likely to be cognitive or system-related?
Cognitive
A review of 25 year of US malpractice claim pay-outs found that what kind of errors accounted for the following:
• Largest fraction of claims
• Most severe patient harm
• Highest total of penalty pay-outs
Diagnostic errors
not surgical mistakes or medication overdoses
What do clinicians combine intuitive understanding of probabilities with to make decisions?
- Cognitive process called heuristics
- These are often referred to as rules of thumb, educated guesses or mental shortcuts (that ease the cognitive load of making a decision)
- Involve a pattern recognition and rely on subconscious integration of patient data with prior experience
- Speeds up practice but can be a cause of misdiagnosis
What are the 2 systems for decision making?
1) Hot system • quick, urgent decisions • reflexive • simple • emotional
2) Cold system • longer • reflective • complex • cognitive
What did a “consumer study” with tights in a shopping mall show?
- 4 identical tights were laid out in a row
- Consumers were significantly more likely to select the far right most pair
- Consumers were also able to provide justifications for their choice e.g. sheerness, strength
Shows the effect of System 1 (hot) in reflexive decision making
What is confirmatory bias?
- The tendency to search or seek, interpret, and recall information in a way the confirms one’s pre-existing beliefs, often leading to errors
- People tend to seek information that confirms their view
- e.g. people who voted to leave the EU would want to read newspapers that support brexit
Why is confirmatory bias risky in diagnostic terms?
- Our initial diagnostic ideas are the ones that we investigate
- We may ignore investigations that contradict our diagnoses
- We must be sure to test for alternatives when evaluating a diagnosis
Does over-confidence increase accuracy?
Studies have shown that it does not
What is a Sunk Cost and the Sunk Cost Fallacy?
Sunk Costs
• Any costs spent on a project that are irretrievable e.g. money spent on building a house or expensive drugs to treat a patient
Sunk Cost Fallacy
• Rationally, the only factor affecting future action should be future costs/benefit ration
• However, often the more we have invested in the past, the more we are prepared to invest in a problem in the future
What is ‘anchoring’ and how do retailers take advantage of this?
- A cognitive bias where an individual relies too heavily on an initial piece of information offered when making decisions
- Retailers tell you the ‘was’ price and the ‘offer’ price
What is ‘representativeness heuristic’?
Subjective probability that a stimulus belongs to a particular class based on how typical of the class it appears to be
- often useful in everyday life
- but can result in neglect of relevant base rates
A patient has come back with a positive mammogram. What calculation can be used to work out the probability that the patient has cancer?
Bayes’ Theorem
Are older adults more likely to agree to treatment if it is positively or neutrally/negatively framed?
Positive (what you are going to gain from treatment, rather than what you will lose from not having treatment)
