Clinical decision making

Question 1

Define medical error

Answer 1

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).

• 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.

Question 2

See WJ case study

Answer 2

See WJ case study

Question 3

See Nurse-Doctor relationship

Answer 3

See nurse-doctor relatioship

Question 4

Clinical decision making

Answer 4

See slides

Question 5

What are the two systems for decision making?

Answer 5

Hot system (system 1)
Cold system (system 2)

See slides

Question 6

Describe the Nisbett and Wilson (1977)

Answer 6

An experimenter conducted a “consumer study” in a shopping mall. He laid out four pairs of tights in a row and asked consumers to pick out the pair they liked the best. In reality all four were identical. However, consumers were significantly more likely to select the far right most pair (even though they were switched around randomly each time).

Moreover when asked about their selection the consumers were able to provide justifications for their choice e.g. sheerness, strength etc. None mentioned the position, indeed when the experimenter suggested that position may have influenced their choice they looked at him as if he was mad!

System 1 (Hot) often controls our actions automatically but system 2 (Cold) is blissfully unaware, believing itself to be in charge!

Question 7

What is the confirmatory bias?

Answer 7

• The tendency to search for or seek, interpret, and recall information in a way that confirms one’s preexisting beliefs or hypotheses, often leading to errors
• Is confirmation bias to blame for the ineffective medical procedures that were used for centuries before the arrival of scientific medicine?
• When evaluating a diagnosis be sure to test for alternatives

Question 8

Describe study used to show overconfidence in medicine?

Answer 8

• Podbregar and colleagues studied 126 patients who died in the ICU and underwent autopsy
• Physicians were asked to provide theclinical diagnosis and also their level of uncertainty
• Clinicians who were “completely certain” of the diagnosis ante-mortem were wrong 40% of the time

Question 9

Describe sunk cost fallacy

Answer 9

See slides

Question 10

Describe anchoring?

Answer 10

Individuals poor at adjusting estimates from a given starting point (probs. & values)

Adjustments crude & imprecise

Anchored by starting point

See slides for clinical context

Question 11

Describe representative heuristic?

Answer 11

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)

While often very useful in everyday life, it can also result in neglect of relevant base rates and other errors.

Question 12

Give an example of framing - loss or gain

Answer 12

Patient choice:
“Out of 100 patients taking this drug 70% get better”

    	vs

“Out of 100 patients taking this drug 30% don’t get better”

Question 13

Describe the availability heurisitic?

Answer 13

• 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 weigh their judgments toward more recent information

Question 14

How can decision making be improved?

Answer 14

See slides

1) education and training
2) feedback
3) accountability
4) generating alternatives
5) consulation