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 e.g. Nurse-DR obedience
What is Confirmatory Bias?
The tendency to search for/ interpret information in a way that confirms one’s preconceptions, often leading to errors
What is the Sunk Cost Fallacy?
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
e.g. time waiting for a bus
What is the Anchoring Effect?
People start with an implicitly suggested reference point (the anchor) + make adjustments to it to reach their estimate: it influences the way people intuitively assess probabilities
= a cognitive bias describing the tendency to rely too heavily on the 1st piece of info. 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?
A theorem that measures conditional probability
Used in screening that involves false positives + false negatives e.g. mammograms/breast cancer
State some strategies for improving clinical decision-making.
Recognise heuristics + biases may be affecting our judgement even though we may not be conscious of them
Conduct audits + follow-ups to gain feedback
Establish clear accountability for decisions made
Generate alternative theories + looking for evidence to support them
Use 2nd opinions, algorithms + decision support systems
List 4 examples of medical error
Incorrect diagnosis
Failure to employ indicated tests
Error in performance of operation/ test
Error in dose/ method of using a drug
How are clinical decisions made?
With intuitive understanding of probabilities combined with heuristics to guide judgement
What are heuristics?
“Rules of thumb”
Involve pattern recognition
Rely on subconscious integration of patient data with prior experience
What are Kahneman’s 2 systems for decision making?
“Hot”(System 1)= Quick, almost reflexive decisions, accentuated by stress
“Cold”(System 2)= Slower, relies on putting information together, attenuated by stress
What is representativeness heuristics?
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)
Give a clinical example of representativeness heuristics
60 yr old experienced SOB, sweat, clammy, nausea, feeling faint
Not a typical profile of MI (typically characterised by chest pain)
It’d be unwise to dismiss MI because it has variable presentations
How does framing influence decision making of a patient?
Patients are much more likely to choose an option they gain from e.g. 70% of people get better from this drug
