Clinical Decision Making Flashcards
define 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).
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
what are the two systems for decision making?
Hot system
Cold system
what is hot system
system 1 emotional go simple reflective fast develops early accentuated by stress stimulus control
what is cold system
system 2 cognitive know complex reflective slow develops late attenuated by stress self control
define confirmatory bias:
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
what is sunk cost fallacy
- 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
what is anchoring
Individuals poor at adjusting estimates from a given starting point (probs. & values)
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)
- While often very useful in everyday life, it can also result in neglect of relevant base rates and other errors.
correlation between framing and age
When presented with treatment descriptions described in positive, negative, or neutral terms, 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 or negatively
how can decision making be improved
1) Education and Training Integrate teaching about cognitive error and diagnostic error into medical school curricula Recognise that heuristics and biases may be affecting our judgement even though we may not be conscious of them
2) Feedback Increase number of autopsies Conduct regular and systematic audits Follow-up patients
3) Accountability Establish clear accountability and follow-up for decisions made
4) Generating alternatives Establish forced consideration of alternative possibilities e.g., the generation and working through of a differential diagnosis. Encourage routinely asking the question: What else might this be?
5) Consultation Seek second opinions Use of algorithms Use of clinical decision making support system
what is an algorithm?
An algorithm is a procedure which, if followed exactly, will provide the most likely answer based on the evidence.
