Clinical Decision Making Flashcards
Describe the effect of extraneous factors on clinical decision-making using an example.
Junior-senior relationship may lead to the wrong decision being made
What is Confirmatory Bias?
The tendency to search for or interpret information in a way that confirms one’s preconceptions, often leading to errors
What is the Sunk Cost Fallacy?
-also known as Concorde effect
Rationally, the only factor affecting future action should be future cost/benefit ratio BUT humans do not always act rationally
Often, the more we have invested in the past, the more we are prepared to invest in a problem in the future
What is the Anchoring Effect?
People start with an implicitly suggested reference point (the anchor) and make adjustments to it to reach their estimate – it influences the way people intuitively assess probabilities
In other words, it is a cognitive bias that describes the tendency to rely too heavily on the first piece of information offered when making decisions. Once the anchor is set, future decisions are made by adjusting away from that anchor
What is Gambler’s Fallacy?
A logical fallacy involving the mistaken belief that past events will affect future events when dealing with independent events
Define conditional probability.
Measures the probability of an event happening given that another event has occurred
What is Bayes’ theorem and what is it used for?
It is a theorem that measures conditional probability
It is used in screening that involves false positives and false negatives such as mammograms/breast cancer
State some strategies for improving clinical decision-making.
- Education and Training
- recognise that heuristics and biases may be affecting our judgement even though we may not be conscious of them
- Integrate teaching about cognitive error and diagnostic error into medical school curricula - Generating alternatives
- counteract the effect of top-down processing by generating alternative theories and looking for evidence to support them rather than just looking for evidence that confirms our preferred theory (confirmatory bias) - Feedback
- Increase number of autopsies
- Conduct regular and systematic audits
- Follow-up patients - Consultation
- Use of algorithms and decision support systems - Accountability
- Establish clear accountability and follow-up for decisions made
Define a sunk cost
any costs that have been spent on a project that are irretrievable
Define anchoring
- a psychological heuristic (cognitive shortcut that may result in a suboptimal outcome) that influences the way people intuitively asses probabilities
What is The Availability Heuristic?
- 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
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)
e. g a fit healthy 60 man with vague chest pain that goes away, should not dismiss him in case of MI as common in that age category
What are Kahnemans’s two systems for decision making?
“Hot” system (System 1) Emotional “Go” Simple Reflexive Fast Develops early Accentuated by stress Stimulus control
“Cold” system (System 2) Cognitive “Know” Complex Reflective Slow Develops late Attenuated by stress Self control
Give some examples of general heuristics we use?
Rule of thumb
Educated guesses
Mental shortcuts
