Recognizing Heuristics and Bias in Clinical Decision-making

Abstract

Cognitive bias in surgical decision-making is poorly understood and may represent a bias blind spot relative to the more commonly described and discussed forms of overt bias (ie, race or sex bias). Surgical care is unique in that we often need to make quick, decisive clinical decisions. Surgeons become acclimated to this type of fast-acting, quick-thinking throughout training, where this type of decision-making is critical to our individual success and, in some cases, is critical to the preservation of patients’ life, limbs, or vital organs. Although there are many scenarios where rapid decisions and swift action allow surgeons to effectively do their job, this type of reasoning is also the most susceptible to reliance on heuristics and introduction of cognitive bias. This characterization of fast-thinking as susceptible to bias is described by the dual process theory, which defines 2 types of reasoning each with their own strengths and limitations. The implication of these 2 types of reasoning in both professional and personal settings was the topic of the best-selling novel “Thinking Fast and Slow,” in which type I reasoning is intuitive, fast, usually effective but more likely to fail than type II reasoning, which is analytic, reliable, and safe but also time and resource intense.1–3 Type I reasoning, although fast and often accurate, is at high risk of introducing bias and resulting in incorrect conclusions. Furthermore, when this model of reasoning leads to an incorrect…