Medicine and heuristics: cognitive biases and medical decision-making

Introduction Clinical decision-making is a daily practice conducted by medical practitioners, yet the processes surrounding it are poorly understood. The influence of 'shortcuts' in clinical decision-making, known as heuristics, remains unknown. This paper explores heuristics and the valuable role they play in medical practice, as well as offering potential solutions to minimize the risk of incorrect decision-making. Method The quasi-systematic review was conducted according to modified PRISMA guidelines utilizing the electronic databases Medline, Embase and Cinahl. All English language papers including bias and the medical profession were included. Papers with evidence from other healthcare professions were included if medical practitioners were in the study sample. Discussion The most common decisional shortcuts used in medicine are the Availability, Anchoring and Confirmatory heuristics. The Representativeness, Overconfidence and Bandwagon effects are also prevalent in medical practice. Heuristics are mostly positive but can also result in negative consequences if not utilized appropriately. Factors such as personality and level of experience may influence a doctor's use of heuristics. Heuristics are influenced by the context and conditions in which they are performed. Mitigating strategies such as reflective practice and technology may reduce the likelihood of inappropriate use. Conclusion It remains unknown if heuristics are primarily positive or negative for clinical decision-making. Future efforts should assess heuristics in real-time and controlled trials should be applied to assess the potential impact of mitigating factors in reducing the negative impact of heuristics and optimizing their efficiency for positive outcomes.