Thoughts On Medical Decision Making

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Original article by Jerome Groopman

We all fall victim to habitual behaviors, and more so when we are unable to focus sufficient attention on tasks at hand, believing (consciously or unconsciously) that we can accomplish some process or task without conscious thought, instead thinking about ‘more pressing’ matters.

What is more difficult to detect are those biases not based on habit, but instead on other factors. Groopman’s article on medical decision making explored this issue in the light of decisions made every day by physicians in practices and hospitals across the world.

Several types of errors were explored, including Representativeness error (thinking that is overly influenced by what is typically true), Availability error (the tendency to judge likelihood of an event by how easy relevant examples come to mind), confirmation bias error (cognitive cherry picking – confirming what you expect to find by selectively accepting or ignoring information) and affective error (making decisions based on what you wish to be true).

The stories he shared demonstrate how a very skilled and educated doctor can make incredibly dangerous mistakes, due in some cases to the fast-paced world of medicine but in other in reaction to common human urges such as the desire to be merciful and spare a patient embarrassment or further fatiguing tests.

At my workplace we are tasked with making medical industry communication more secure and much more efficient – resulting in better patient care and increased physician and clinician satisfaction. After reading this article and having learned a great deal about how complex the communication needs of a hospital or practice have become, I have to wonder how many mistakes are made due to the very real problems of workflow dissolution and workplace communication breakdowns. How many errors of the classes described by Groopman could be avoided or reduced in severity through more frequent and higher quality peer-to-peer interactions in the medical industry?

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