Healthy Skepticism Library item: 2077

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Publication type: Journal Article

Hall KH.
Reviewing intuitive decision-making and uncertainty: the implications for medical education.
Med Educ 2002 Mar; 36:(3):216-24
http://www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2923.2002.01140.x

Abstract:

CONTEXT: Intuition and uncertainty are inescapable conditions of many instances of clinical decision- making. Under such conditions biases and heuristics may operate, distorting the decision-making process. Physicians and students are generally unaware of these influences.

PURPOSE: To review the extant literature regarding the role of uncertainty and intuition and associated biases on medical decision-making, to highlight the implications this holds for medical education.

CONTENT: Using literature identified via Medline and Bioethicsline searches of the past 3 decades, this paper reviews the sources of uncertainty in clinical practice and the role of intuitive decision-making. A detailed description of associated heuristics and biases is provided, and linked with demonstrable examples from medical decision-making.

CONCLUSIONS: It is argued that although uncertainty can be reduced, it can never be completely eliminated from decision-making. Therefore most decision-making performed in medicine contains an irreducible intuitive element and is thus vulnerable to these biases and heuristics. Given that few medical curricula overtly address the process of medical decision-making, both medical students and physicians remain vulnerable to these effects on their own (and their patients’) decision-making. Insight via education appears the major means in which to avoid distorting decision-making processes.

Keywords:
Publication Types: Review MeSH Terms: Clinical Competence Decision Making* Education, Medical/standards Humans Mental Recall Prejudice