![]() The dual-process theory, a cognitive model of reasoning, can be particularly relevant in matters of clinical decision making. We can help mitigate failures of clinical reasoning by helping physicians and trainees cultivate insight into their own thinking processes. Metacognition and Clinical Decision Making Although the relation between decisions and outcomes might seem intuitive, the outcome of a decision cannot be the sole determinant of its quality that is, sometimes a good outcome can happen despite a poor clinical decision, and vice versa. 3 Feedback on clinical decisions is critical for identifying weaknesses or potential mistakes, so this type of bias can prevent clinicians from taking into account appropriate feedback to improve future performance. ![]() This bias refers to the practice of believing that good or bad results are always attributable to prior decisions, even when there is no valid reason to do so. 6įurther down the treatment pathway, outcomes bias can come into play. 3 The affect heuristic is context or patient specific and can manifest when physicians label patients as “complainers” or when they experience positive or negative feelings toward a patient, based on prior experiences. This is called the affect heuristic, and, while heuristics can often serve as efficient approaches to problem solving, they can sometimes lead to bias. When physicians move from deliberation to action, they are sometimes swayed by emotional reactions rather than rational deliberation about risks and benefits. 3 For example, a patient’s back pain might be attributed to known osteoporosis without ruling out other potential causes. It often manifests when the first piece of information given to a physician is relied upon too heavily when making decisions. It refers to physicians’ practices of prioritizing information and data that support their initial impressions, even when first impressions are wrong. 5Īnchoring bias is closely related to confirmation bias and comes into play when interpreting evidence. Since it occurs early in the treatment pathway, confirmation bias can lead to mistaken diagnoses being passed on to and accepted by other clinicians without their validity being questioned, a process referred to as diagnostic momentum. This bias leads physicians to see what they want to see. 4 It can occur when a physician refuses to consider alternative diagnoses once an initial diagnosis has been established, despite contradicting data, such as lab results. Examples of Cognitive BiasesĬonfirmation bias is the selective gathering and interpretation of evidence consistent with current beliefs and the neglect of evidence that contradicts them. We then discuss specific debiasing strategies and how to integrate them into education. In this article, we first discuss these biases, how they affect medical decision making, and how cognitive psychology helps to inform effective debiasing strategies. 3 Although experts have identified many different types of cognitive biases, specific examples from these domains include confirmation bias, anchoring bias, the affect heuristic, and outcomes bias. 1,2 A 2016 review of their roles in decision making lists 4 domains of concern for physicians: gathering and interpreting evidence, taking action, and evaluating decisions. ![]() IntroductionĬognitive biases contribute significantly to diagnostic and treatment errors. ![]() Learning effective debiasing strategies and cultivating awareness of confirmation, anchoring, and outcomes biases and the affect heuristic, among others, and their effects on clinical decision making should be prioritized in all stages of education. Like all humans, health professionals are subject to cognitive biases that can render diagnoses and treatment decisions vulnerable to error.
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