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
[41]   SYSTEMS SIMULATION DECISION STRATEGIES IN SIMULATED ENVIRONMENTS [J].
KLEINMUNTZ, DN ;
KLEINMUNTZ, B .
BEHAVIORAL SCIENCE, 1981, 26 (03) :294-305
[42]   FAILURE OF INFORMATION AS AN INTERVENTION TO MODIFY CLINICAL MANAGEMENT - A TIME-SERIES TRIAL IN PATIENTS WITH ACUTE CHEST PAIN [J].
LEE, TH ;
PEARSON, SD ;
JOHNSON, PA ;
GARCIA, TB ;
WEISBERG, MC ;
GUADAGNOLI, E ;
COOK, F ;
GOLDMAN, L .
ANNALS OF INTERNAL MEDICINE, 1995, 122 (06) :434-437
[44]   TREATMENT PREFERENCES OF PATIENTS AND PHYSICIANS - INFLUENCES OF SUMMARY DATA WHEN FRAMING EFFECTS ARE CONTROLLED [J].
MAZUR, DJ ;
HICKAM, DH .
MEDICAL DECISION MAKING, 1990, 10 (01) :2-5
[45]   Users' guides to the medical literature - XX. Integrating research evidence with the care of the individual patient [J].
McAlister, FA ;
Straus, SE ;
Guyatt, GH ;
Haynes, RB .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 283 (21) :2829-2836
[46]   ON THE ELICITATION OF PREFERENCES FOR ALTERNATIVE THERAPIES [J].
MCNEIL, BJ ;
PAUKER, SG ;
SOX, HC ;
TVERSKY, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1982, 306 (21) :1259-1262
[47]   CORRELATED SYMPTOMS AND SIMULATED MEDICAL CLASSIFICATION [J].
MEDIN, DL ;
EDELSON, SM ;
ALTOM, MW ;
FREKO, D .
JOURNAL OF EXPERIMENTAL PSYCHOLOGY-HUMAN LEARNING AND MEMORY, 1982, 8 (01) :37-50
[48]   DEALING WITH UNCERTAINTY, RISKS, AND TRADEOFFS IN CLINICAL DECISIONS - A COGNITIVE SCIENCE APPROACH [J].
MOSKOWITZ, AJ ;
KUIPERS, BJ ;
KASSIRER, JP .
ANNALS OF INTERNAL MEDICINE, 1988, 108 (03) :435-449
[49]   AVAILABILITY, WISHFUL THINKING, AND PHYSICIANS DIAGNOSTIC JUDGMENTS FOR PATIENTS WITH SUSPECTED BACTEREMIA [J].
POSES, RM ;
ANTHONY, M .
MEDICAL DECISION MAKING, 1991, 11 (03) :159-168
[50]   UNDERSTANDING PATIENTS DECISIONS - COGNITIVE AND EMOTIONAL PERSPECTIVES [J].
REDELMEIER, DA ;
ROZIN, P ;
KAHNEMAN, D .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 270 (01) :72-76