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Thursday, December 5, 2013

The Consequences of the Hindsight Bias in Medical Decision Making

By Hal Arkes
doi: 10.1177/0963721413489988
Current Directions in Psychological Science October 2013 vol. 22 no. 5 356-360

Abstract

The hindsight bias manifests in the tendency to exaggerate the extent to which a past event could have been predicted beforehand. This bias has particularly detrimental effects in the domain of medical decision making. I present a demonstration of the bias, its contribution to overconfidence, and its involvement in judgments of medical malpractice. Finally, I point out that physicians and psychologists can collaborate to the mutual benefit of both professions.

The hindsight bias manifests in the tendency to exaggerate the extent to which a past event could have been predicted beforehand. First systematically investigated by Fischhoff (1975), the bias is sometimes called “Monday morning quarterbacking” or the “I knew-it-all-along effect” (Wood, 1978). The hindsight bias has particularly detrimental effects in the domain of medical decision making. I begin with the classic study demonstrating how the bias diminishes the salutary impact of a medical education exercise.

The Hindsight Bias as an Impediment to Learning

A clinicopathologic conference (CPC) is a dramatic event at a hospital. A young physician, such as a resident, is given all of the documentation except the autopsy report that pertains to a deceased patient. After studying the material for a week or so, the physician presents the case to the assembled medical staff, going over the case and listing the differential diagnosis, which consists of the several possible diagnoses for this patient. Finally, the presenting physician announces the diagnosis that he or she thinks is the correct one. The presenter then sits down, sweating profusely, as the pathologist who did the autopsy takes the podium and announces the correct diagnosis. The cases are chosen because they are difficult, so the presenting physician’s hypothesis often is incorrect.

The entire article is here, behind a pay wall.  Hopefully you can obtain it through your university library.
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