5B. Clinical Decision Making

Question 1

What is confirmatory bias?

Answer 1

Tendency to search for/ interpret information that confirms your pre-existing opinion

Question 2

Name the fallacy you have to learn about clinical decision making

Answer 2

Sunk Cost

Question 3

Explain the Sunk Cost Fallacy

Answer 3

The more we invested in the past, the more likely we are to going to continue investing in this even if it may not be the best decision to make

Question 4

What are the 2 types of heuristics?

Answer 4

Availability

Representativeness

Question 5

What is availability heuristics?

Answer 5

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

Question 6

What sort of outcomes are typically overestimated in availability heuristics?

Answer 6

Catastrophic/ dramatic

Question 7

Give an example of availability heuristics at work in a clinical decision making setting

Answer 7

Clinician recently misses diagnosis –> more likely to then be overcautious and may over-diagnose in the future

Question 8

Describe representativeness heuristics

Answer 8

Probabilities estimated on basis of how ‘typical’ the stimulus is of that class, REGARDLESS OF BASE RATE PROBABILITY

Question 9

Give an example of representativeness heuristics at work in a clinical decision making setting

Answer 9

Relatively fir -looking lean 60 year old man having chest pain and dismissing MI because he is not a typical CVD patient

Question 10

Recall 4 strategies for improving clinical decision making

Answer 10

1. Education to make us aware of eg heuristics
2. Feedback eg autopsy to see if it was the correct diagnosis
3. establish clear accountability
4. Consider alternatives (avoid confirmatory bias)
5. Consultation - seek second opinion/algorithms

Question 11

What is the Kahneman 2 systems of decision making?

Answer 11

Hot system/system 1 - fast, reflexive, accentuated by stress

Cold system/system 2 - slow, reflective, attenuated by stress