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Monday, November 29, 2021

People use mental shortcuts to make difficult decisions – even highly trained doctors delivering babies

Manasvini Singh
The Conversation
Originally published 14 OCT 21

Here is an excerpt:

Useful time-saver or dangerous bias?

A bias arising from a heuristic implies a deviation from an “optimal” decision. However, identifying the optimal decision in real life is difficult because you usually don’t know what could have been: the counterfactual. This is especially relevant in medicine.

Take the win-stay/lose-shift strategy, for example. There are other studies that show that after “bad” events, physicians switch strategies. Missing an important diagnosis makes physicians test more on subsequent patients. Experiencing complications with a drug makes the physician less likely to prescribe it again.

But from a learning perspective, it’s difficult to say that ordering a test after missing a diagnosis is a flawed heuristic. Ordering a test always increases the chance that the physician catches an important diagnosis. So it’s a useful heuristic in some instances – say, for example, the physician had been underordering tests before, or the patient or insurer prefers shelling out the extra money for the chance to detect a cancer early.

In my study, though, switching delivery modes after complications offers no documented guarantees of avoiding future complications. And there is the added consideration of the short- and long-term health consequences of delivery-mode choice for mother and baby. Further, people are generally less tolerant of having inappropriate medical procedures performed on them than they are of being the recipients of unnecessary tests.

Tweaking the heuristic

Can physicians’ reliance on heuristics be lessened? Possibly.

Decision support systems that assist physicians with important clinical decisions are gathering momentum in medicine, and could help doctors course-correct after emotional events such as delivery complications.

For example, such algorithms can be built into electronic health records and perform a variety of tasks: flag physician decisions that appear nonstandard, identify patients who could benefit from a particular decision, summarize clinical information in ways that make it easier for physicians to digest and so on. As long as physicians retain at least some autonomy, decision support systems can do just that – support doctors in making clinical decisions.

Nudges that unobtrusively encourage physicians to make certain decisions can be accomplished by tinkering with the way options are presented – what’s called “choice architecture.” They already work for other clinical decisions.