Psychological Perspectives on Medical Decision Making and Problem Solving Flashcards
How many diagnosis is missed or delayed
Diagnosis missed or delayed in 5% - 14% of acute hospital admissions
What are the diagnostic error rates in autopsy studies
Autopsy studies confirm diagnostic error rates of 10% - 20%
how many patients do not receive evidence based care
Up to 45% of patients (acute and chronic) do not receive evidence based care
how many drugs and investigations are unnecessary
Between 20% - 30% of investigations and drugs administered are potentially unnecessary
What do half of errors involve in terms of decision making, investigators and drugs and diagnosis
Almost half of these errors involved reasoning or decision quality (failure to elicit, synthesise, decide or act on clinical information)
How many diagnosis that clinicians were certain of were proven wrong at autopsy
in a study 40% of diagnoses about which clinicians were certain were proven wrong at autopsy
Clinicians may stick to a diagnosis even when colleagues or decision tools suggest they’re wrong
What did the department of health 2000a report that
- Staff didn’t know what to report or why
- If the patient was ‘unharmed’ then the error didn’t matter
- Staff felt too busy to report
- There was a lack of feedback when errors were reported
- There was a fear or disciplinary action or litigation (for self or colleagues)
what are the explanatory models of human error
- Persons approach
- Weakness of the person approach
Describe the explanatory models of human error
Person approach
- Healthcare professional is responsible
- Forgetfulness, negligence, poor motivation, carelessness, inattention
- Also known as ‘active errors
Weakness of the person approach
- Prevents analysis of what went wrong – so no opportunity to change it
- Failure to recognise that most mistakes happen in patterns
- Suggests that mistakes are only made by ‘bad’ doctors
What does the system approach that
Mistakes are inevitable because humans are fallible
Errors are consequences rather than causes - unworkable procedures, inadequate equipment, fatigue, understaffing
Describe a model inductive clinical reasoning versus the hypothetico-deductive model
Model Inductive
- initial collection of information from history and examination
- series of logical problem solving steps (Algorithms)
- diagnosis
Hypothetico-Deductive
- collection of information
- generation of hypothesis
- analysis of information to confirm or refute the hypothesis
- diagnosis
What are heuristics
Cognitive shortcuts /decisional shortcuts
What is type 1 thinking
Type 1 thinking is fast, intuitive, unconscious thought, Most everyday activities
What is type 2 thinking
System 2 is the deliberate type of thinking involved in focus, deliberation, reasoning or analysis – such as calculating a complex math problem,
describe pattern recognition
- quick
- intuitive
What is pattern recognition based of of
Based on experience of lots and lots of cases
- Means that atypical presentations can still be spotted
- That the experienced doctor will know what additional information is needed to complete the clinical picture
What are cognitive biases
Systematic and predictable errors in judgement, resulting from reliance on heuristics
Describe availability bias
Things seem more likely if they readily come to mind
So a disease seen recently will seem more likely
What is the problem with representativeness bias
- Diagnosis seems more likely based on how similar the characteristics are to typical cases
- Only looks for prototypical manifestations of disease
Describe what anchoring is
Perceived probability of event or diagnosis based on one trait or piece of information
- don’t look for or consider other information
What is diagnosis momentum
- Once labels are attached to patients they get stickier and stickier
- Because the staff and family around the patient also use the diagnosis it becomes definite
- And it’s hard to go back and change it so all other possibilities are excluded
What is fundamental attribution error
The tendency to blame people for their illness rather than the circumstances
This occurs particularly for psychiatric patients, minorities, those with substance abuse issues and other marginalised groups
What is commission bias
- The tendency to action rather than inaction
- This can be problematic in many ways – prescribing tests or medication which are not necessary
- It’s more common in over-confident doctors (people?)
- But it’s also a function of what patients expect of medical encounters.
How do you get rid of cogntivie bias
Develop insight/awareness
Consider alternatives
Metacognition (reflection)
Decrease reliance on memory
Specific training (like this lecture!)
Simulation
Make the task easier
Minimise time pressures
Establish accountability and possibility of feedback
What makes up cognitive biases
Availability Representativeness Anchoring Diagnosis Momentum Fundamental Attribution Error Commissioning bias
What is the role of the patient
- Shared decision making
What is the role of the doctors
The nature of clinical problems – biomedical or psychosocial?
Existing knowledge of the patient
Stereotypes
Mood
Age, gender, weight, geographical location and own behaviour
