Supervision of Students May Protect Academic Physicians from Cognitive Bias: A Study of Decision Making and Multiple Treatment Alternatives in Medicine

Roswarski, Todd Eric; Murray, Michael D.

doi:10.1177/0272989x06286483

Cited by 21 publications

(20 citation statements)

References 15 publications

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“…This study, like ours, does not mean to establish which decision is better; it only demonstrates the difference in recommendations. These differences might be explained by cognitive biases leading to errors in processing information that can interfere with optimal decision-making [8,23,24]. For example, there is a difference in weighting of dimensions; someone deciding for others typically weights only one or a few dimensions, whereas people deciding for themselves weight multiple dimensions [18].…”

Section: Discussionmentioning

confidence: 99%

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Janssen

Teunis

Guitton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences. Questions/purposes (1) Are surgeons more likely to recommend surgery when choosing for a patient than for themselves? (2) Are surgeons less confident in deciding for patients than for themselves?Methods Two hundred fifty-four (32%) of 790 Science of Variation Group (SOVG) members reviewed 21 fictional upper extremity cases (eg, distal radius fracture, De Quervain tendinopathy) for which surgery is optional answering two questions: (1) What treatment would you choose/recommend: operative or nonoperative? (2) On a scale from 0 to 10, how confident are you about this decision? Confidence is the degree that one believes that his or her decision is the right one (ie, most appropriate). Participants were orthopaedic, trauma, and plastic surgeons, all with an interest in 123 Clin Orthop Relat Res (2015) 473:3564-3572 DOI 10.1007/s11999-015-4304-z Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® treating upperextremity conditions. Half of the participants were randomized to choose for themselves if they had this injury or illness. The other half was randomized to make treatment recommendations for a patient of their age and gender. For the choice of operative or nonoperative, the overall recommendation for treatment was expressed as a surgery score per surgeon by dividing the number of cases they would operate on by the total number of cases (n = 21), where 100% is when every surgeon recommended surgery for every case. For confidence, we calculated the mean confidence for all 21 cases per surgeon; overall score ranges from 0 to 10 with a higher score indicating more confidence in the decision for treatment. Results Surgeons were more likely to recommend surgery for a patient (44.2% ± 14.0%) than they were to choose surgery for themselves (38.5% ± 15.4%) with a mean difference of 6% (95% confidence interval [CI], 2.1%-9.4%; p = 0.002). Surgeons were more confident in deciding for themselves than they were for a patient of similar age and gender (self: 7.9 ± 1.0, patient: 7.5 ± 1.2, mean difference: 0.35 [CI, 0.075-0.62], p = 0.012). Conclusions Surgeons are slightly more likely to recommend surgery for a patient than they are to choose surgery for themselves and they choose for themselves with a little more confidence. Different perspectives, preferences, circumstantial information, and cognitive biases might explain the observed differences. This emphasizes the importance of (1) understanding patients' preferences and their considerations for treatment; (2) being aware that surgeons and patients might weigh various factors differently; (3) giving patients more autonomy by letting them balance risks and benefits themselves (ie, shared decisionmaking); and (4) assessing how dispassionate evidencebased decision aids help...

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Section: Discussionmentioning

confidence: 99%

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Janssen

Teunis

Guitton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Traditional economic theory holds that more choice is better as the optimum over a proper subset can never be larger than the optimum over the original set. While a rational decision maker benefits from a wealth of choice, studies have found that larger choice sets can reduce one's satisfaction with the decision (Iyengar and Lepper 2000), the likelihood of making a decision (Redelmeier and Shafir 1995, Iyengar and Lepper 2000, Roswarski and Murray 2006, and the quality and optimality of the decision (Payne et al 1993, Tanius et al 2009, Schram and Sonnemans 2011, Hanoch et al 2011, Besedeš et al 2012a,b, and Heiss et al 2013.…”

Section: Introductionmentioning

confidence: 99%

Reducing Choice Overload without Reducing Choices

Besedeš

Deck²,

Sarangi

et al. 2015

Review of Economics and Statistics

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Previous studies have demonstrated that a multitude of options can lead to choice overload, reducing decision quality. Through controlled experiments, we examine sequential choice architectures that enable the choice set to remain large while potentially reducing the effect of choice overload. A specific tournament-style architecture achieves this goal. An alternate architecture in which subjects compare each subset of options to the most preferred option encountered thus far fails to improve performance due to the status quo bias. Subject preferences over different choice architectures are negatively correlated with performance, suggesting that providing choice over architectures might reduce the quality of decisions. JEL Codes: C91, D03

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“…Iyengar and Lepper (2000) show that consumers encountering a large assortment of jams or chocolates are less likely to make a purchase or express satisfaction with their choice than consumers presented with a smaller assortment. Redelmeier and Shafir (1995) and Roswarski and Murray (2006) show that physicians offered a greater choice of drugs to prescribe are less likely to prescribe any drug, while Iyengar et al (2004) and Agnew and Szykman (2005) show that enrollment in workplace retirement savings plans decreases with the number of choices provided.…”

Section: Introductionmentioning

confidence: 99%

Age Effects and Heuristics in Decision Making

Besedeš

Deck

Sarangi

et al. 2012

Review of Economics and Statistics

113

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Using controlled experiments, we examine how individuals make choices when faced with multiple options. Choice tasks are designed to mimic the selection of health insurance, prescription drug, or retirement savings plans. In our experiment, available options can be objectively ranked allowing us to examine optimal decision making. First, the probability of a person selecting the optimal option declines as the number of options increases, with the decline being more pronounced for older subjects. Second, heuristics differ by age with older subjects relying more on suboptimal decision rules. In a heuristics validation experiment, older subjects make worse decisions than younger subjects.

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Supervision of Students May Protect Academic Physicians from Cognitive Bias: A Study of Decision Making and Multiple Treatment Alternatives in Medicine

Cited by 21 publications

References 15 publications

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Reducing Choice Overload without Reducing Choices

Age Effects and Heuristics in Decision Making

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