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Cited by 15Clinical Reasoning and Diagnostic SkillsDecision-Making and Behavioral EconomicsHealth Sciences Research and Education

Cognitive Biases Cloud Our Clinical Decisions and Patient Expectations: A Narrative Review to Help Bridge the Gap between Evidence-Based and Personalized Medicine

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Gojanovic, Boris, Fourchet, François, Gremeaux, Vincent·2022·Annals of Physical and Rehabilitation Medicine
DOI 10.1016/j.rehab.2021.101551
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Abstract

In sports medicine and rehabilitation of musculoskeletal conditions, training, knowledge and expertise of clinicians are the guarantors of good clinical practice. But are they really? Since the 1970s, a growing body of sociological and behavioral science has developed the concepts of cognitive biases and thinking errors. In a nutshell, it tries to explain how we approach decision-making using shortcuts, or heuristics. Our brains will alternatively use 2 systems to think and decide: system 1 is fast, intuitive and emotional, whereas system 2 is slow, logical and conscious. We may think clinicians use the latter systematically, but they actually use system 1 in many situations. Whether due to intrinsic thinking errors or external forces that cloud our judgment, we are under unconscious influences and so are all the stakeholders in the rehabilitation setting, including the patient/athlete. We present some of the most prevalent biases that pervade clinical decision-making and attempt to give a bit of background context starting from the typical tension between academic authority and personal experience. The field of sports performance is also riddled with beliefs, egocentrism and a general tendency to search for magic bullets that will bring the marginal gains and edge over the competition. This plays into the rehabilitation of patient-athletes in different ways. Finally, there are ways to mitigate the effect of cognitive biases to improve decision-making. This must include better communication, shared decisions and ultimately the understanding that we should drive our profession to deliver high-value care tailored to the patients, in line with the best evidence at the best possible cost. Hopefully, we can shed some light without too many of our own biases on the complexities of thinking in sports medicine and rehabilitation.

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  • System 1 thinking can lead to judgment errors and cognitive biases, such as anchoring, confirmation, attribution, availability, confidence, and delay discounting.

    “it can also lead to judgment errors and cognitive biases [92,93], such as anchoring, confirmation, attribution, availability, confidence, and delay discounting.”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [93]

    Section 4 links cognitive biases to System 1 thinking, and the paper discusses anchoring, confirmation, availability, overconfidence, and a short-term preference it calls hyperbolic discounting. Our copy does not identify attribution bias as such, so it does not fully support the cited list. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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2 of the 31 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Porter ME. Olmsted teisberg E. redefining health care: creating value-based com- petition on results. Boston: Harvard Business Review Press; 2006.

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Related

Authors
Gojanovic, B., Fourchet, F., & Gremeaux, V.
Affiliations
Hôpital de la Tour (CH)
Corresponding author
Gojanovic, Boris
ORCID
Venue
Annals of Physical and Rehabilitation Medicine
Publisher
Elsevier BV
Published
2022-06
Volume
65
Issue
4
Pages
101551
ISSN
1877-0657 (ISSN-L)
DOI
10.1016/j.rehab.2021.101551
OpenAlex
W3175915426
Cited by
15
References
31
Citations by year
2026: 1 · 2025: 3 · 2024: 6 · 2023: 3 · 2022: 2
FWCI
0.64
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of Physical and Rehabilitation Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
Keywords
cognitive biases, clinical decision-making, heuristics, System 1 and System 2, patient expectations, personalized medicine, evidence-based medicine, sports medicine, shared decision-making, clinician-patient communication, high-value care, self-centeredness, marginal gains
MeSH terms
Cognition, Decision Making, Humans, Motivation, Bias, Precision Medicine

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