Clinical decision Making Flashcards
How many deaths have medication errors contributed to and what would it cost the NHS
12,000 deaths per year in the NHS
0.75billion-1.5 billion
What are the causes of medical errors
Both system-related and cognitive factors
Cognitive error only
System-related error only
No-fault factors only
What is Kahneman’s two systems for decision making
System 1: Hot system, that allows us to make decisions very quickly. It is very reflexive, and allows us to respond to situations urgently.
System 2: Much more of a reflective system, which takes a bit longer. It involves more weighing up of probabilities and calculations. This is good for precision, but NOT for fast decision-making.
Compare the hot system of decision making to the cold system
Emotional vs cognitive Go vs know Simple vs complex Reflexive vs reflective Fast vs slow Develops early vs late Accentuated by stress vs attenuated Stimulus vs self control
What is confirmatory bias
The tendency to search for or seek, interpret and recall information in a way that confirms one’s pre-existing beliefs or hypotheses often leading to errors
What are sunk costs
Any costs that have been spent on a project that are irretrievable
What is the sunk cost fallacy
The more we have invested in the past the more we are prepared to invest in a problem in the future
But rationally, the only factor affecting future action should be the future costs/benefit ratio.
What are heuristics
Cognitive processes
Rules of thumb, educated guesses, or mental shortcuts that come from experience and helps the individual think through things
Describe 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 weight their judgments towards more recent information
Describe the represemtativeness 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 this is often very useful in daily life, it can also result in neglect of relevant base rates and other errors
What is the following scenario an example of:
a clinician who recently missed the diagnosis of pulmonary embolism in a healthy young woman who had vague chest discomfort but no other clinical findings or apparent risk factors might then overestimate the risk in similar patients and become more likely to do CT pulmonary angiography for similar patients despite the very small probability of disease.
Availability heuristic
What is the following scenario and example of:
several hours of vague chest discomfort in a thin, athletic, healthy-appearing 60-yr-old man who has no known medical problems and who now looks and feels well does NOT match the typical profile of an MI, however, it would be unwise to dismiss that possibility because MI is common among men of that age and has highly variable manifestations
Representative heuristic
Give some strategies for improving clinical decision making
Recognize that heuristics and biases may be affecting our judgment even though we may not be conscious of them
Counteract the effect of top-down information processing by generating alternative theories and looking for evidence to support them rather than just looking for evidence that confirms our preferred theory.
Understand and employ statistical principles e.g. Bayes Theorem
Use of Algorithms and decision support systems
What is anchoring
Individuals are poor at adjusting estimates from a given starting point
Adjustments are crude and imprecise and anchored by a starting point
