Reviewing intuitive decision-making and uncertainty: the implications for medical education

Abstract

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.

Provider Recommendations for Colorectal Cancer Screening in Elderly Veterans

“…This is consistent with the evidence that clinicians rely on biases and heuristics in decisionmaking, and these factors ("intuitive" decision making 24 ) play a larger role as uncertainty increases 25 . The impact of the new USPSTF guidelines on CRC screening practices in the VA system is yet to be determined, and it would be interesting to compare our findings with data collected after the publication of the guidelines.…”

When Should Patient Intuition be Taken Seriously?

“…6 In the West, the value of reasoned thinking has been extolled since the Enlightenment 7 and strengthened by evidence that intuition can be prone to producing biased or inaccurate judgments. 8,9 However, evidence-based medicine also recognizes that clinical expertise, including intuition, is needed to integrate the clinical state and circumstances, research evidence, and patient preferences and actions. 10 Moreover, discrimination between subtle stimuli and integrative processing are central to clinical skills such as ultrasonography 11 and are highly valued [12][13][14] by the patient-centered clinical method, which uses patient experience to help guide clinical interactions and shared decision making.…”

Diagnosis of depersonalization disorder

“…Such biases are frequently related to the use of cognitive heuristics (Hall, 2002;Tversky & Kahneman, 1974) and prototypes in clinical decision-making (Garb, 2005). Heuristics have been described as "...a rule or guideline that is easily applied to make complex tasks more simple" (Detmer, Fryback, & Gassner, 1978, p. 682).…”

“…Heuristics have been described as "...a rule or guideline that is easily applied to make complex tasks more simple" (Detmer, Fryback, & Gassner, 1978, p. 682). As such, heuristics may be considered decision-making short-cuts that, although expeditious, can lead to decreased decisional accuracy (Hall, 2002).…”