Medical Decision Making

Question 1

What are the 2 approaches to human error?

Answer 1

Person Approach

Systemic Approach

Question 2

What is the person approach to human error?

Answer 2

• health professional responsible

- active errors include forgetfulness/negligence/poor motivation/carelessness/inattention

Question 3

What are the weaknesses of person approach to human error?

Answer 3

• prevents analysis of what went wrong
• failure to recognise patterns of mistakes
• suggests mistakes only made by bad doctors

Question 4

What is the systemic approach of human error?

Answer 4

• assumes mistakes are inevitable because humans are fallible
• errors are consequences rather than causes
• best prevention in a system defending against human error

Question 5

How may errors be consequences rather than causes?

Answer 5

• unworkable procedures
• inadequate equipment
• fatigue
• understaffing

Question 6

What is heuristics?

Answer 6

cognitive shortcuts/decisional shortcuts

• educated guess, common sense, rule of thumb
• can lead to cognitive biases

Question 7

What are cognitive biases?

Answer 7

Systemic and predictable errors in judgement due to reliance on heuristics

Question 8

What are some examples of cognitive biases?

Answer 8

• availability (readily comes to mind = seems more likely, dramatic, recently seen)
• representativeness (seems more likely as typical characteristics present)
• anchoring (first impression)
• diagnosis momentum (labels attached to patients so hard to go back and chane)
• fundamental attribution error (blaming people for illness rather than circumstances)
• commissioning bias (tendency to act rather than inact, perhaps unnecessarily)

Question 9

What is the difference between informed decision making and shared decision making?

Answer 9

Informed = responsibility lies with patient, patient decides on treatment, doctor just provides

Shared = both doctor and patient involved, doctor gives expert opinion, decide on treatment together

Question 10

What is the inductive clinical reasoning model?

Answer 10

Inductive clinical reasoning:

• for novices
• collection information from history and exam -> problem solving steps -> diagnosis

Question 11

What is the hypothetico-deductive model?

Answer 11

• collect information from history and examination
• generate hypothesis
• analyse information to confirm or refute hypothesis
• diagnose
• for experts

Question 12

What are the 2 systems to making decisions?

Answer 12

• pattern recognition/quick/intuitive/based on experience
  vs.
• heuristics