Clinical Decision Making Flashcards
What is to blame for common medical errors?
System-related AND cognitive factors
cognitive ranked higher
Define confirmation bias
Tendency to search or interpret information in a way which confirms one’s own perconceptions
Define sunk cost
Any costs that have been spent on a project that are irretrievable ranging including anything from money spent from building a house to expensive drugs
Explain the sunk cost fallacy
The only factor affecting future action should be the future cost/benefits 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 – the “Sunk Cost Fallacy” or “Concorde effect”.
Define anchoring
A psychological heuristic that influences the way people intuitively assess probabilities
Heuristic = cognitive shortcut that may result in a suboptimal outcome
Explain anchoring & adjustment
Per this heuristic, people start with the implicitly suggested reference point (the “anchor”) and adjust it to reach their estimate (adjustments)
o I.E. A price of an item says “Reduced from £100 to £50” then we think this is a great deal (even if it’s not worth £50) as the anchor is £100
Define Gambler’s Fallacy
A logical fallacy involving the mistaken belief that past events will affect future events when dealing with random activities, such as with gambling games
Framing effect on clinical decision making?
Framing effect – When presented with treatment descriptions, described in positive, negative or neutral terms:
o Older adults – more likely to agree to treatment described in positive terms as opposed to neutrally or negative
Define heuristics
Rules of thumb, educated guesses, mental shortcuts
i.e. fast & frugal approaches to thinking
Involves
• pattern recognition
AND
• subconscious integration of patient data with prior experience
2 types of heuristics
Representativeness
Availability
Representativeness heuristic?
The subjective probability that a stimulus belongs to a certain class based on how ‘typical’ of that class it appears to be regardless of the base rate probability.
• e.g. fit and young 60yo man with vague chest pain that goes away. You should NOT dismiss him in case of MI as its common in that age category
Availability heuristic?
Probabilities are estimated based on how easily and/or vividly they can be called to mind.
• e.g. the patient has whatever your last patient who looked like this had
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
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 systems
Define algorithm
A logical series of steps to take to decide most effectively, but not necessarily most efficiently
