Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Cognitive Errors. Show all posts
Showing posts with label Cognitive Errors. Show all posts

Sunday, November 1, 2020

Believing in Overcoming Cognitive Biases

T. S. Doherty & A. E. Carroll
AMA J Ethics. 2020;22(9):E773-778. 
doi: 10.1001/amajethics.2020.773.

Abstract

Like all humans, health professionals are subject to cognitive biases that can render diagnoses and treatment decisions vulnerable to error. 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.

Here is an excerpt:

The practice of reflection reinforces behaviors that reduce bias in complex situations. A 2016 systematic review of cognitive intervention studies found that guided reflection interventions were associated with the most consistent success in improving diagnostic reasoning. A guided reflection intervention involves searching for and being open to alternative diagnoses and willingness to engage in thoughtful and effortful reasoning and reflection on one’s own conclusions, all with supportive feedback or challenge from a mentor.

The same review suggests that cognitive forcing strategies may also have some success in improving diagnostic outcomes. These strategies involve conscious consideration of alternative diagnoses other than those that come intuitively. One example involves reading radiographs in the emergency department. According to studies, a common pitfall among inexperienced clinicians in such a situation is to call off the search once a positive finding has been noticed, which often leads to other abnormalities (eg, second fractures) being overlooked. Thus, the forcing strategy in this situation would be to continue a search even after an initial fracture has been detected.

Monday, June 18, 2018

Sam Harris and the Myth of Perfectly Rational Thought

Robert Wright
www.wired.com
Originally posted March 17, 2018

Here are several excerpts:

This is attribution error working as designed. It sustains your conviction that, though your team may do bad things, it’s only the other team that’s actually bad. Your badness is “situational,” theirs is “dispositional.”

(cut)

Another cognitive bias—probably the most famous—is confirmation bias, the tendency to embrace, perhaps uncritically, evidence that supports your side of an argument and to either not notice, reject, or forget evidence that undermines it. This bias can assume various forms, and one was exhibited by Harris in his exchange with Ezra Klein over political scientist Charles Murray’s controversial views on race and IQ.

(cut)

Most of these examples of tribal thinking are pretty pedestrian—the kinds of biases we all exhibit, usually with less than catastrophic results. Still, it is these and other such pedestrian distortions of thought and perception that drive America’s political polarization today.

For example: How different is what Harris said about Buzzfeed from Donald Trump talking about “fake news CNN”? It’s certainly different in degree. But is it different in kind? I would submit that it’s not.

When a society is healthy, it is saved from all this by robust communication. Individual people still embrace or reject evidence too hastily, still apportion blame tribally, but civil contact with people of different perspectives can keep the resulting distortions within bounds. There is enough constructive cross-tribal communication—and enough agreement on what the credible sources of information are—to preserve some overlap of, and some fruitful interaction between, world views.

The article is here.

Monday, July 10, 2017

When Are Doctors Too Old to Practice?

By Lucette Lagnado
The Wall Street Journal
Originally posted June 24, 2017

Here is an excerpt:

Testing older physicians for mental and physical ability is growing more common. Nearly a fourth of physicians in America are 65 or older, and 40% of these are actively involved in patient care, according to the American Medical Association. Experts at the AMA have suggested that they be screened lest they pose a risk to patients. An AMA working group is considering guidelines.

Concern over older physicians' mental states--and whether it is safe for them to care for patients--has prompted a number of institutions, from Stanford Health Care in Palo Alto, Calif., to Driscoll Children's Hospital in Corpus Christi, Texas, to the University of Virginia Health System, to adopt age-related physician policies in recent years. The goal is to spot problems, in particular signs of cognitive decline or dementia.

Now, as more institutions like Cooper embrace the measures, they are roiling some older doctors and raising questions of fairness, scientific validity--and ageism.

"It is not for the faint of heart, this policy," said Ann Weinacker, 66, the former chief of staff at the hospital and professor of medicine at Stanford University who has overseen the controversial efforts to implement age-related screening at Stanford hospital.

A group of doctors has been battling Stanford's age-based physician policies for the past five years, contending they are demeaning and discriminatory. The older doctors got the medical staff to scrap a mental-competency exam aimed at testing for cognitive impairment. Most, like Frank Stockdale, an 81-year-old breast-cancer specialist, refused to take it.

The article is here.

Monday, April 11, 2016

The Sunk Cost Fallacy

David McRaney
You are Not So Smart Blog: The Celebration of Self-Delusion
Originally published March 25, 2011 (and still relevant)

The Misconception: You make rational decisions based on the future value of objects, investments and experiences.

The Truth: Your decisions are tainted by the emotional investments you accumulate, and the more you invest in something the harder it becomes to abandon it.

The blog post is here.

Note: This heuristic may be one reason psychologists hang onto patients longer than required.

Saturday, May 31, 2014

Forced to be free? Increasing patient autonomy by constraining it

By Neil Levy
Journal of Medical Ethics
Originally published February 2010

ABSTRACT

It is universally accepted in bioethics that doctors and other medical professionals have an obligation to procure the informed consent of their patients. Informed consent is required because patients have the moral right to autonomy in furthering the pursuit of their most important goals. In the present work, it is argued that evidence from psychology shows that human beings are subject to a number of biases and limitations as reasoners, which can be expected to lower the quality of their decisions and which therefore make it more difficult for them to pursue their most important goals by giving informed consent. It is further argued that patient autonomy is best promoted by constraining the informed consent procedure. By limiting the degree of freedom patients have to choose, the good that informed consent is supposed to protect can be promoted.

The entire article is here.