Medical Decision Making Flashcards
What are the 2 approaches to human error?
Person Approach
Systemic Approach
What is the person approach to human error?
- health professional responsible
- active errors include forgetfulness/negligence/poor motivation/carelessness/inattention
What are the weaknesses of person approach to human error?
- prevents analysis of what went wrong
- failure to recognise patterns of mistakes
- suggests mistakes only made by bad doctors
What is the systemic approach of human error?
- assumes mistakes are inevitable because humans are fallible
- errors are consequences rather than causes
- best prevention in a system defending against human error
How may errors be consequences rather than causes?
- unworkable procedures
- inadequate equipment
- fatigue
- understaffing
What is heuristics?
cognitive shortcuts/decisional shortcuts
- educated guess, common sense, rule of thumb
- can lead to cognitive biases
What are cognitive biases?
Systemic and predictable errors in judgement due to reliance on heuristics
What are some examples of cognitive biases?
- availability (readily comes to mind = seems more likely, dramatic, recently seen)
- representativeness (seems more likely as typical characteristics present)
- anchoring (first impression)
- diagnosis momentum (labels attached to patients so hard to go back and chane)
- fundamental attribution error (blaming people for illness rather than circumstances)
- commissioning bias (tendency to act rather than inact, perhaps unnecessarily)
What is the difference between informed decision making and shared decision making?
Informed = responsibility lies with patient, patient decides on treatment, doctor just provides
Shared = both doctor and patient involved, doctor gives expert opinion, decide on treatment together
What is the inductive clinical reasoning model?
Inductive clinical reasoning:
- for novices
- collection information from history and exam -> problem solving steps -> diagnosis
What is the hypothetico-deductive model?
- collect information from history and examination
- generate hypothesis
- analyse information to confirm or refute hypothesis
- diagnose
- for experts
What are the 2 systems to making decisions?
- pattern recognition/quick/intuitive/based on experience
vs. - heuristics