Rationality in medical decision making: a review of the literature on doctors' decision-making biases

被引:221
作者
Bornstein, BH [1 ]
Emler, AC [1 ]
机构
[1] Louisiana State Univ, Baton Rouge, LA 70803 USA
关键词
biases; medical decision making;
D O I
10.1046/j.1365-2753.2001.00284.x
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
The objectives of this study were to describe ways in which doctors make suboptimal diagnostic and treatment decisions, and to discuss possible means of alleviating those biases, using a review of past studies from the psychological and medical decision-making literatures. A number of biases can affect the ways in which doctors gather and use evidence in making diagnoses. Biases also exist in how doctors make treatment decisions once a definitive diagnosis has been made. These biases are not peculiar to the medical domain but, rather, are manifestations of suboptimal reasoning to which people are susceptible in general. None the less, they can have potentially grave consequences in medical settings, such as erroneous diagnosis or patient: mismanagement. No surefire methods exist for eliminating biases in medical decision making, but there is some evidence that the adoption of an evidence-based medicine approach or the incorporation of formal decision analytic tools can improve the quality of doctors' reasoning. Doctors' reasoning is vulnerable to a number of biases that can lead to errors in diagnosis and treatment, but there are positive signs that means for alleviating some of these biases are available.
引用
收藏
页码:97 / 107
页数:11
相关论文
共 59 条
[1]  
[Anonymous], 1988, Decision making: Descriptive, normative, and prescriptive interactions, DOI DOI 10.1017/CBO9780511598951.028
[2]  
[Anonymous], DECISION MAKING DESC
[3]  
[Anonymous], REASONING INFERENCE
[4]   HINDSIGHT BIAS AMONG PHYSICIANS WEIGHING THE LIKELIHOOD OF DIAGNOSES [J].
ARKES, HR ;
SAVILLE, PD ;
WORTMANN, RL ;
HARKNESS, AR .
JOURNAL OF APPLIED PSYCHOLOGY, 1981, 66 (02) :252-254
[5]  
ARNOULT LH, 1988, REASONING INFERENCE, P209
[6]   DO PHYSICIANS HAVE A BIAS TOWARD ACTION - A CLASSIC STUDY REVISITED [J].
AYANIAN, JZ ;
BERWICK, DM .
MEDICAL DECISION MAKING, 1991, 11 (03) :154-158
[7]   PSEUDODOXIA PEDIATRICA [J].
BAKWIN, H .
NEW ENGLAND JOURNAL OF MEDICINE, 1945, 232 (24) :691-697
[8]  
BELLD E, 1988, DECISION MAKING DESC
[9]   ADVANCES IN DIAGNOSTIC-IMAGING AND OVERESTIMATIONS OF DISEASE PREVALENCE AND THE BENEFITS OF THERAPY [J].
BLACK, WC ;
WELCH, HG .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 328 (17) :1237-1243
[10]   SOME EXAMPLES OF REGRESSION TOWARDS THE MEAN .7. [J].
BLAND, JM ;
ALTMAN, DG .
BRITISH MEDICAL JOURNAL, 1994, 309 (6957) :780-780