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If we are to truly Live Clinically, it is imperative we utilize critical thinking in our decision-making process. Critical thinking can be an arduous process and our brain typically prefers use as little effort as possible. This is where biases and heuristics come into play. A heuristic is a simple decision strategy that ignores part of the available information and focuses on the few relevant predictors. They are useful and often vital (developed as survival mechanism when there is insufficient time to critically appraise a situation) but sometimes lead to severe and systematic errors.
Elstein refers to heuristics as “mental shortcuts commonly used in decision making that can lead to faulty reasoning or conclusions,” citing them as a source of many errors in clinical reasoning. We will cover many of these systematic errors and biases in upcoming posts and how they relate to our clinical practice. There is an overwhelming amount of literature available to all of us, however, if we don’t know how to critically appraise it, apply it, analyze its usage, and make revisions in our practice then we will be limited in the quality of care we provide and revert to old habits. In addition, without the ability to analyze our own thoughts and actions, we become subjected to the information relayed by others and our natural tendencies. After all, sticking with what we already “know” is much easier than challenging our thoughts and assumptions.
Critical appraisal is difficult, as is challenging information we hear and see on a regular basis. Daniel Kahneman, winner of the Nobel prize in economics and author of Thinking Fast and Slow summarized this process well. He stated, “the essence of intuitive heuristics [is] when faced with a difficult question, we often answer an easier one instead, usually without noticing the substitution.” Our challenge to each of you is to challenge your potential biases and intuitions. This is not to say act and speak with uncertainty in all you do. When making a decision, stick with it. However, when you have opportunity to reflect, be critical of the information available and the additional information needed.
The two systems as defined by Kahneman. Both fast and slow thinking have their place. The key is recognition and to know when it is time to thinking slowly and when quick decisions are needed. (image source: upfrontanalytics.com)
‘Heuristic decision making in medicine’ by Julian N Marewski and Gerd Gigerenzer is a great article on this topic as it relates to the healthcare space. Our hope is the information provided in this series will enhance further study of the literature and assessment of your treatment and interactions in the clinic. Or as McDonald writes, “admitting the role of heuristics confers no shame. Rather, the goal should be to formalize and understand heuristics so that their use can be effectively taught, which could lead to less practice variation and more efficient medical care.” It’s not realistic for us to eliminate all biases, but instead, let’s aim to accurately identify them so we may decide when we need to slow down and take our time in making a decision and acting.
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