4. Clinical decision making Flashcards
what is a 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)
give examples of medical errors
- incorrect diagnosis - failure to employ indicated tests - error in the performance of an operation, procedure or test - error in the dose or method of using a drug
define heuristics
cognitive processes which guide clinical judgement and are often referred to as rules of thumb, educated guesses or mental shortcuts usually involve pattern recognition and rely on a subconscious integration of patient data with prior experience
What is Kahnemans 2 system for decision making?
- “hot” system (system 1) - “cold” system (system 2).
- System 1: Hot system, that allows us to make decisions very quickly. It is very reflexive, and allows us to respond to situations urgently.
- System 2: Much more of a reflective system, which takes a bit longer. It involves more weighing up of probabilities and calculations. This is good for precision, but NOT for fast decision-making.
what is the “hot” system for decision making?
allows us to make decisions very quickly it is reflexive and allows us to response to situations urgently
what is the “cold” system for decision making?
reflective system which takes longer involves weighing up probabilities and calculations and is good for precision but not for fast decision-making
what is confirmatory bias?
the tendency to search for or seek, interpret, and recall information in a way that confirms one’s pre-existing beliefs or hypotheses, often leading to errors people tend to seek information that confirms their view.
why can confirmatory bias be risky in terms of diagnostics?
our initial diagnostic ideas are the ones that we investigate we may ignore investigations that contradict our diagnoses, and only focus on the ones that support them
what are sunk costs?
sunk costs are any costs (not necessarily financial) that have been spent on a project that are irretrievable, including anything from money spent building a house to expensive drugs used to treat a patient with a rare disease.
- Sunk costs are any costs that have been spent on a project that are irretrievable ranging.
- (explanation:) the more we have invested in the past the more we are prepared to invest in a problem in the future. But rationally, the only factor affecting future action should be the future costs/benefit ratio.
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 the more we have invested in the past the more we are prepared to invest in a problem in the future.
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. Rationally the only factor affecting future action should be the future costs/benefit ratio but humans do not always act rationally and often 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 or the “Concorde Effect”.
what is the anchoring effect?
a cognitive bias for an individual to rely too heavily on an initial piece of information offered (known as the “anchor”) when making decisions.
Anchoring and adjustment is a psychological heuristic that influences the way people intuitively assess probabilities. According to this heuristic, people start with an implicitly suggested reference point (the “anchor”) and make adjustments to it to reach their estimate.
give one clinical and one non-clinical example of the anchoring effect
clinical: doctor dismissing a patient of having acute pancreatitis even though he has epigastric pain and nausea because he began by saying he had not drank alcohol for many years and investigations showed normal blood levels of pancreatic enzymes
non-clinical: retailers telling shoppers the ‘was’ price as well as the ‘offer’ price
what is the effect of framing on age?
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/negatively
what is the representativeness heuristic?
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) (we estimate the likelihood of an event by comparing it to an existing prototype that already exists in our minds)
Representativeness heuristic:
Example: several hours of vague chest discomfort in a thin, athletic, healthy-appearing 60-yr-old man who has no known medical problems and who now looks and feels well does NOT match the typical profile of an MI, however, it would be unwise to dismiss that possibility because MI is common among men of that age and has highly variable manifestations
what is the availability heuristic?
making judgments about the likelihood of an event based on how easily an example, instance, or case comes to mind.
Availability Heuristics
- Probabilities are estimated on the basis of how easily and/or vividly they can be called to mind
- Individuals typically overestimate the frequency of occurrence of catastrophic, dramatic events e.g. surveys show 80% believe that accidents cause more deaths than strokes
- People tend to heavily weight their judgments towards more recent information
Example: a clinician who recently missed the diagnosis of pulmonary embolism in a healthy young woman who had vague chest discomfort but no other clinical findings or apparent risk factors might then overestimate the risk in similar patients and become more likely to do CT pulmonary angiography for similar patients despite the very small probability of disease.
