Abstract
Medical decision-making is a complex process that often takes place during uncertainty, that is, when knowledge, time, and resources are limited. How can we ensure good decisions? We present research on heuristics—simple rules of thumb—and discuss how medical decision-making can benefit from these tools. We challenge the common view that heuristics are only second-best solutions by showing that they can be more accur ate, faster, and easier to apply in comparison to more complex strategies. Using the example of fast-and-frugal decision trees, we illustrate how heuristics can be studied and implemented in the medical context. Finally, we suggest how a heuristic-friendly culture supports the study and application of heuristics as complementary strategies to existing decision rules.
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American College of Emergency Physicians (2014) Definition of emergency medicine http://www.acep.org/content.aspx?id=29164
Gigerenzer G, Gaissmaier W (2011) Heuristic decision making. Annu Rev Psychol 62:451–482. doi:10.1146/annurev-psych-120709-145346
Tversky A, Kahneman D (1974) Judgment under uncertainty: heuristics and biases. Science 185:1124–1131. doi:10.1126/science.185.4157.1124
Kahneman D (2003) Maps of bounded rationality: psychology for behavioral economics. Am Econ Rev 93:1449–1475. doi:10.1257/000282803322655392
Payne JW, Bettman JR, Johnson EJ (1993) The adaptive decision maker. Cambridge University Press, New York
Bornstein BH, Emler AC (2001) Rationality in medical decision making: a review of the literature on doctors’ decision-making biases. J Eval Clin Pract 7:97–107
Elstein AS (1999) Heuristics and biases: selected errors in clinical reasoning. Acad Med 74:791–794
Hall KH (2002) Reviewing intuitive decision-making and uncertainty: the implications for medical education. Med Educ 36:216–224
Klein JG (2005) Five pitfalls in decisions about diagnosis and prescribing. BMJ 330:781–784
Gigerenzer G, Todd PM, ABC Research Group (1999) Simple heuristics that make us smart. Oxford University Press, New York
Gigerenzer G, Selten R (2001) Bounded rationality: the adaptive toolbox. MIT Press, Cambridge
Simon HA (1956) Rational choice and the structure of the environment. Psychol Rev 63:129–138. doi:10.1037/h0042769
Hertwig R, Pachur T, Kurzenhäuser S (2005) Judgments of risk frequencies: tests of possible cognitive mechanisms. J Exp Psychol Learn Mem Cogn 31:621–642
Gigerenzer G, Hug K (1992) Domain-specific reasoning: social contracts, cheating, and perspective change. Cognition 43:127–171
Gigerenzer G, Hertwig R, Pachur T (eds) (2011) Heuristics: the foundations of adaptive behavior. Oxford University Press, New York
Goldstein D, Gigerenzer G (2002) Models of ecological rationality: the recognition heuristic. Psychol Rev 109:75–90
Dawes RM (1979) The robust beauty of improper linear models in decision making. Am Psychol 34:571–582
Czerlinski J, Gigerenzer G, Goldstein DG (1999) How good are simple heuristics? In: Gigerenzer G, Todd PM, ABC Research Group (eds) Simple heuristics that make us smart. Oxford University Press, New York, pp 97–118
Gigerenzer G, Brighton H (2009) Homo heuristicus: why biased minds make better inferences. Topics Cogn Sci 1:107–143
Katsikopoulos KV (2011) Psychological heuristics for making inferences: definition, performance, and the emerging theory and practice. Decis Anal 8:10–29
Marewski J, Pohl R, Vitouch O (2010) Recognition-based judgments and decisions: introduction to the special issue (Vol. 1). Judg Dec Mak 5:207–215
Newell BR, Shanks DR (2004) On the role of recognition in decision making. J Exp Psych 30:923–935
DeMiguel V, Garlappi L, Uppal R (2011) Optimal versus naive diversification: how inefficient is the 1/N portfolio strategy. In: Gigerenzer G, Hertwig R, Pachur T (eds) Heuristics: the foundations of adaptive behavior. Oxford University Press, New York, pp 642–668
Hohenemser CR, Kates W, Slovic P (1985) A casual taxonomy. In: Kates RW, Hohenemser C, Kasperson JX (eds) Perilous progress: managing the hazards of technology. Westview Press, Boulder, pp 67–89
Knight F (1921) Risk, uncertainty, and profit. Houghton Mifflin, Boston
Meder B, Le Lec F, Osman M (2013) Decision making in uncertain times: what can cognitive and decision sciences say about or learn from economic crises? Trends Cog Sci 17:257–260
Politi MC, Han PKJ, Col NF (2007) Communicating the uncertainty of harms and benefits of medical interventions. Med Dec Mak 27:681–695. doi:10.1177/0272989X07307270
Feufel MA, Bodemer N (2014) Nudging, social marketing, empowerment: When to use which to improve health decisions? Manuscript under review
Lawrence L (2013). Decision-making rules for diagnosing PE may save lives. Retrieved July 20th, 2014 http://www.acpinternist.org/archives/2013/03/pulmonology.htm
McDonald CJ (1996) Medical heuristics: the silent adjudicators of clinical practice. Ann Intern Med 124:56–62
Groopman J (2007) How doctors think. Houghton Mifflin, Boston
Green L, Mehr DR (1997) What alters physicians’ decisions to admit to the coronary care unit? J Fam Pract 45:219–226
Super G (1984) START: A triage training module. Hoag Memorial Hospital Presbyterian, Newport Beach
Luan S, Schooler L, Gigerenzer G (2011) A signal detection analysis of fast-and-frugal trees. Psychol Rev 118:316–338
Martignon L, Katsikopoulos KV, Woike J (2008) Categorization with limited resources: a family of simple heuristics. J Math Psychol 52:352–361
Gigerenzer G (2014) Risk savvy: how to make good decisions. Viking, New York
Hertwig R, Todd PM (2003) More is not always better: the benefits of cognitive limits. In: Hardman D, Macchi L (eds) Thinking: psychological perspectives on reasoning, judgment and decision making. Wiley, Chichester, pp 213–232
Jenny MA, Pachur T, Williams SL, Becker E, Margraf J (2013) Simple rules for detecting depression. J Appl Res Mem Cogn 2:149–157
Mata J, Frank R, Gigerenzer G (2014) Symptom recognition of heart attack and stroke in nine European countries: a representative study. Health Expect 17:376–387
Clausing DP, Katsikopoulos KV (2008) Rationality in systems engineering: beyond calculation or political action. Syst Eng 11:309–328
Marewski J, Gigerenzer G (2012) Heuristic decision making in medicine. Dialogues Clin Neurosci 14:77–89
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We thank Anita Todd for editing the paper. We thank Giovanni Casazza and Giorgio Costantino for providing valuable feedback along the whole process of writing this manuscript.
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Bodemer, N., Hanoch, Y. & Katsikopoulos, K.V. Heuristics: foundations for a novel approach to medical decision making. Intern Emerg Med 10, 195–203 (2015). https://doi.org/10.1007/s11739-014-1143-y
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DOI: https://doi.org/10.1007/s11739-014-1143-y