Heuristics: Indispensable, yet susceptible to bias
Heuristics are cognitive shortcuts often operating subconsciously to solve problems more quickly and efficiently than if the problem were analyzed and solved deductively.7 The act of driving a car, for instance, is a complex everyday task wherein the use of heuristics is not just efficient but essential. Deliberately analyzing and consciously considering every action required in daily living prior to execution would be impractical and even dangerous.
Heuristics also have a role in the practice of medicine. When presented with a large volume of low-acuity patients, the primary care provider would find it impractical to formulate an extensive differential and test each diagnosis before devising a plan of action. Using heuristics during clinical decision-making, however, does make the clinician more vulnerable to biases, which are described in the text that follows.
Biases
Bias is the psychological tendency to make a decision based on incomplete information and subjective factors rather than empirical evidence.4
Anchoring. One of the best-known biases, described in both behavioral science and medical literature, is anchoring. With this bias, the clinician fixates on a particular aspect of the patient’s initial presentation, excluding other more relevant clinical facts.8
A busy clinician, for example, may be notified by a medical assistant that the patient in Room One is complaining about fatigue and seems very depressed. The clinician then unduly anchors his thought process to this initial label of a depressed patient and, without much deliberation, prescribes an antidepressant medication. Had the physician inquired about skin and hair changes (unusual in depression), the more probable diagnosis of hypothyroidism would have come to mind.
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