Heuristics and biases: selected errors in clinical reasoning
Abstract
Many clinical decisions are made in uncertainty. When the diagnosis is uncertain, the goal is to establish a diagnosis or to treat even if the diagnosis remains unknown. If the diagnosis is known (e.g., breast cancer or prostate cancer) but the treatment is risky and its outcome uncertain, still a choice must be made. In researching the psychology of clinical judgment and decision making, the major strategy is to compare observed clinical judgments and decisions with the normative model established by statistical decision theory. In this framework, the process of diagnosing is conceptualized as using imperfect information to revise opinions; Bayes' theorem is the formal rule for updating a diagnosis as new data are available. Treatment decisions should be made so as to maximize expected value. This essay uses Bayes' theorem and concepts from decision theory to describe and explain some well-documented errors in clinical reasoning. Heuristics and biases are the cognitive factors that produce these errors.
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Diagnostic errors are often attributed to cognitive and/or systems-related factors.
“Although diagnostic errors may occur when signs of a disease are atypical or absent, diagnostic errors are often attributed to cognitive (e.g., faulty clinical reasoning) and/or systems-related factors (e.g., inefficient processes and poor communication7,9–21).”
From Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology (2008) · cites this paper as [11]
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- Authors
- Elstein, A. S.
- Affiliations
- University of Illinois Chicago (US)
- Corresponding author
- Elstein, A S
- Venue
- Academic Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1999-07
- Volume
- 74
- Issue
- 7
- Pages
- 791-4
- ISSN
- 1040-2446 (ISSN-L)
- OpenAlex
- W2094090073
- Cited by
- 285
- References
- 0
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 8 · 2021: 12 · 2020: 7 · 2019: 19 · 2018: 12 · 2017: 12 · 2016: 13 · 2015: 14 · 2014: 22 · 2013: 19 · 2012: 14
- FWCI
- 6.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Medicine (publishedVersion)
- PubMed (publishedVersion)
- 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
- heuristics and biases, clinical judgment, clinical decision-making, diagnostic uncertainty, Bayes' theorem, statistical decision theory, expected value, Bayesian updating, treatment decision-making
- MeSH terms
- Bayes Theorem, Choice Behavior, Cognition, Decision Making, Decision Support Techniques, Decision Theory, Diagnosis, Humans, Judgment, Mental Recall, Risk Factors, Therapeutics, Treatment Outcome
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