Skip to main content
SpringerLink
Log in

Enhancing Medical Decision Making When Caring for the Critically Ill: The Role of Cognitive Heuristics and Biases

  • Chapter
  • First Online:
Cognitive Informatics in Health and Biomedicine

Part of the book series: Health Informatics ((HI))

Abstract

The foundations of human judgment and decision theory have influenced studies on decision making for decades in various domains. A specific area of human judgment is decision-making under conditions of uncertainty. Medicine is an example of decision-making under conditions of uncertainty where doctors constantly make decisions with incomplete information, knowledge gaps and sometimes with inaccurate information. These conditions are exacerbated in critical care environments (Emergency Departments (ED) and Intensive Care Units (ICU)) which are complex in nature with information intensive, time sensitive, highly stressful, non-deterministic, interruption-laden, and life-critical [1]. Caring for critically ill patients within these situations often requires clinicians to make life-and-death decisions within a few seconds while relying on large quantities of questionable information. In order to make these decisions in a timely manner, the clinician must reduce the large quantity of data to a manageable dimension and quickly determine what information is critical to handle the current situation [2]. Studies have shown that individuals often deal with such situations by using cognitive heuristics, or mental shortcuts [1, 2]. Even though the use of heuristics can lead to appropriate judgments, inappropriate heuristic use can result in severe and systematic errors [3–5]. In medicine, such errors include incorrect or delayed diagnosis, and inappropriate or delayed treatment, all of which can result in adverse medical events and patient harm. Due to the severe consequences of medical errors, it is imperative to minimize inappropriate use of cognitive heuristics by developing techniques to identify cognitive heuristic use.

The audio recordings used in this study were collected as part of a larger research project; in addition to recordings, researchers conducted general observation and clinician shadowing. Further information can be found in Abraham, Kannampallil, & Patel, 2012.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Franklin A, Liua Y, Li Z, Nguyen V, Johnson RR, Robinson D, et al. Opportunistic decision making and complexity in emergency care. J Biomed Inform. 2011;44(3):469–76.

    Article  PubMed  Google Scholar 

  2. Patel VL, Evans DA, Kaufman DR. Cognitive framework for doctor-patient interaction. In: Evans DA, Patel VL, editors. Cognitive science in medicine: biomedical modeling. Cambridge, MA: MIT Press; 1989. p. 253–308.

    Google Scholar 

  3. Tversky A, Kahneman D. Judgment under uncertainty: heuristics and biases. Science. 1974;185:1124–31.

    Article  PubMed  CAS  Google Scholar 

  4. Patel VL, Zhang J, Yoskowitz NA, Green RA, Sayan OR. Translational cognition for decision support in critical care environments: a review. J Biomed Inform. 2008;41(3):413–31.

    Article  PubMed  Google Scholar 

  5. Patel VL, Cohen T, Murarka T, Olsen J, Kagita S, Myneni S, et al. Recovery at the edge of error: debunking the myth of the infallible expert. J Biomed Inform. 2011;44(3):413–24. PubMed PMID: 20869466.

    Article  PubMed  Google Scholar 

  6. McDonald CJ. Medical heuristics: the silent adjudicators of clinical practice. Ann Intern Med. 1996;124:56–62.

    Article  PubMed  CAS  Google Scholar 

  7. Simon HA. Rational choice and the structure of the environment. In: Simon HA, editor. Models of man. New York: John Wiley; 1957.

    Google Scholar 

  8. Richards M, Wierzbicki M. Anchoring effects in clinical like judgments. J Clin Psychol. 1990;46:358–65.

    Article  PubMed  CAS  Google Scholar 

  9. Dragotoniu A, Robinson D, Patel B, Patel VL. Perceptions of cognitive biases in decision making by critical care clinicians and lay persons. unpublished work.

    Google Scholar 

  10. Slovic P. Thinking. In: Osherson D, Smith E, editors. An invitation to cognitive science. Cambridge, MA: MIT Press; 1990.

    Google Scholar 

  11. Redelmeier DA, Koehler DJ, Liberman V, Tversky A. Probability judgment in medicine: discounting unspecified possibilities. Med Decis Making. 1995;15:227–30.

    Article  PubMed  CAS  Google Scholar 

  12. Edwards W. The theory of decision making. Psychol Bull. 1954;51:380–417.

    Article  PubMed  CAS  Google Scholar 

  13. Kahneman D, Tversky A. On the psychology of prediction. Psychol Rev. 1973;80:237–51.

    Article  Google Scholar 

  14. Johnson-Laird P. Mental models and deduction. Trends Cogn Sci. 2001;5:434–43.

    Article  PubMed  Google Scholar 

  15. Evans JSB. In two minds: dual-process accounts of reasoning. Trends Cogn Sci. 2003;7:454–9.

    Article  PubMed  Google Scholar 

  16. Redelmeier DA, Ferris L, Tu J, Hux J, Schull M. Problems for clinical judgment: introducing cognitive psychology as one more basic science. CMAJ. 2001;164:358–60.

    PubMed  CAS  Google Scholar 

  17. Redelmeier DA, Shafir E. Medical decision-making in situations that offer multiple alternatives. JAMA. 1995;271:302–5.

    Article  Google Scholar 

  18. Simon HA. Theories of bounded rationality. In: McGuire C, Radner R, editors. Decision and Organization. Amsterdam: North-Holland Publishing Company; 1972. p. 161–76.

    Google Scholar 

  19. Patel VL, Kaufman DR, Arocha JF. Emerging paradigms of cognition in medical decision making. J Biomed Inform. 2002;35:52–75.

    Article  PubMed  Google Scholar 

  20. Hershberger P, Part H, Markert R, Cohen S, Finger W. Development of a test of cognitive bias in medical decision-making. Acad Med. 1994;69:839–42.

    Article  PubMed  CAS  Google Scholar 

  21. Gilovich T, Griffin D. Heuristics and biases: then and now. In: Gilovich T, Kahneman D, editors. Heuristics and biases: the psychology of intuitive judgment. New York: Cambridge University Press; 2005.

    Google Scholar 

  22. Gigerenzer G, Todd P, Group AR. Simple heuristics that make us smart. New York: Oxford University Press; 1999.

    Google Scholar 

  23. Friedlander M, Stockman S. Anchoring and publicity effects in clinical judgment. J Clin Psychol. 1983;39:637–44.

    Article  PubMed  CAS  Google Scholar 

  24. Kahneman D, Tversky A. On the reality of cognitive illusions: a reply to Gigerenzer’s critique. Psychol Rev. 1996;103:582–91.

    Article  PubMed  CAS  Google Scholar 

  25. Kassirer J, Kopelman R. Learning clinical reasoning. Baltimore: Lippincott Williams and Wilkins; 1991.

    Google Scholar 

  26. Plous S. Heuristics and biases. In: The psychology of judgment and decision-making. New York: McGraw-Hill; 1993.

    Google Scholar 

  27. Croskerry P. Achieving quality in clinical decision-making: cognitive strategies and detection of bias. Acad Emerg Med. 2002;9:1184–204.

    Article  PubMed  Google Scholar 

  28. Pines J. Profiles in patient safety: confirmation bias in emergency medicine. Acad Emerg Med. 2006;13:90–4.

    PubMed  Google Scholar 

  29. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78(8):775–80. PubMed PMID: 12915363.

    Article  PubMed  Google Scholar 

  30. Huber J, Payne JW, Puto C. Adding asymmetrically dominated alternatives: violations of regularity and the similarity hypothesis. J Consum Res. 1982;9:90–8.

    Article  Google Scholar 

  31. Ellis M, Robbins E, Schult D, Ladany N, Banker J. Anchoring errors in clinical judgments: type I error, adjustment or mitigation? J Couns Psychol. 1990;37:343–51.

    Article  Google Scholar 

  32. Elstein A. Heuristics and biases: selected errors in clinical reasoning. Acad Med. 1999;74:791–4.

    Article  PubMed  CAS  Google Scholar 

  33. Graber M, Gordon R, Franklin N. Reducing diagnostic errors in medicine: what is the goal? Acad Med. 2002;77:981–92.

    Article  PubMed  Google Scholar 

  34. Kempainen R, Migeon M, Wolf F. Understanding our mistakes: a primer on errors in clinical reasoning. Med Teach. 2003;25:177–81.

    Article  PubMed  Google Scholar 

  35. Chapman GB, Elstein AS. Cognitive processes and biases in medical decision-making. In: Chapman GB, Sonnenberg FS, editors. Decision-making in health care: theory, psychology, and applications Cambridge. Cambridge/New York: Cambridge University Press; 2000. p. 183–210.

    Google Scholar 

  36. Sternberg RJ, Sternberg K. Cognitive psychology. Belmont: Wadsworth Cengage Learning; 2009.

    Google Scholar 

  37. Poses R, Anthony M. Availability, wishful thinking, and physicians’ diagnostic judgments for patients with suspected bacteremia. Med Decis Making. 1991;11:159–68.

    Article  PubMed  CAS  Google Scholar 

  38. Spranca M, Minsk E, Baaron J. Omission and commission in judgment and choice. J Exp Soc Psychol. 1991;27:76–105.

    Article  Google Scholar 

  39. Gruppen L, Margolin J, Wisdom K, Grum C. Outcome bias and cognitive dissonance in evaluating treatment decisions. Acad Med. 1994;69:S57–9.

    Article  PubMed  CAS  Google Scholar 

  40. Chapman GB, Bornstein BH, Elmer AC. The sunk cost fallacy in medical management decisions. Med Decis Making. 1996;16:452.

    Google Scholar 

  41. Bornstein BH, Elmer AC, Chapman GB. Is there a sunk cost effect in medical treatment decisions? Soc Sci Med. 1999;49:215–22.

    Article  PubMed  CAS  Google Scholar 

  42. Baaron J, Ritov I. Reference points and omission bias. Organ Behav Hum Decis Process. 1994;59:475–98.

    Article  Google Scholar 

  43. Birks M, Mills J. Grounded theory, a practical guide. Thousand Oaks: Sage Publications; 2011.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Houston Veterans Affairs, Health Services Research and Development Center of Excellence, Houston, TX, 77030, USA

    Velma L. Payne PhD, MS (BMI), MBA, MS (CIS)

  2. School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, 77054, USA

    Velma L. Payne PhD, MS (BMI), MBA, MS (CIS)

  3. Center for Cognitive Studies in Medicine and Public Health, New York Academy of Medicine, New York, NY, 10029, USA

    Vimla L. Patel PhD, DSc, FRSC

  4. Department of Biomedical Informatics, Columbia University, New York, NY, 10032, USA

    Vimla L. Patel PhD, DSc, FRSC

  5. Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ, 85259, USA

    Vimla L. Patel PhD, DSc, FRSC

Authors
  1. Velma L. Payne PhD, MS (BMI), MBA, MS (CIS)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vimla L. Patel PhD, DSc, FRSC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Velma L. Payne PhD, MS (BMI), MBA, MS (CIS) .

Editor information

Editors and Affiliations

  1. New York Academy of Medicine, New York, New York, USA

    Vimla L. Patel

  2. Arizona State University, Scottsdale, Arizona, USA

    David R. Kaufman

  3. University of Texas Health Science Center, Houston, Texas, USA

    Trevor Cohen

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Payne, V.L., Patel, V.L. (2014). Enhancing Medical Decision Making When Caring for the Critically Ill: The Role of Cognitive Heuristics and Biases. In: Patel, V., Kaufman, D., Cohen, T. (eds) Cognitive Informatics in Health and Biomedicine. Health Informatics. Springer, London. https://doi.org/10.1007/978-1-4471-5490-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5490-7_10

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5489-1

  • Online ISBN: 978-1-4471-5490-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation