Every day we make countless decisions. Many may not seem to be important, or have any significant consequences, but they all require brain power to assess the situation and decide the best course of action.

To save time and energy we develop cognitive short-cuts to help make these decisions, speeding up the process and helping us cope with the complexities of daily living.

But what happens when the world of cognitive short-cuts and healthcare collide?

Cognitive shortcuts speed up decision-making

More commonly known as a “general rule of thumb”, heuristics are cognitive short-cuts; rules or principles that we broadly apply to sets of similar situations. We build them up over time, creating them from personal experience, trial and error, or learning by others’ examples. As our library of appropriate responses grows, so our decision-making becomes faster, and we more confident in making them.

However, these short-cuts are not known to be particularly accurate or reliable. And despite being largely based on personal and anecdotal experience over any accurate or scientific basis, these “rules of thumb” tend to strongly shape the way we behave in many circumstances, from how much coffee you measure out in the morning to how a doctor in a busy clinic treats their patient.

There are good reasons for having them; heuristics help lighten our cognitive load – or memory resources – when making decisions. Simple situations take a small amount of our resources, but when faced with complex and unique scenarios, we face the risk of analysis paralysis. This occurs when there is too much information to consider for a person to effectively come to a conclusion and act on it. Heuristics prevent this, saving us mental time and energy, and enabling decision-making.

However, along with accelerated problem solving, heuristics also come with a risk of bias.

The problem is, heuristics are based on past experiences

In busy (and often understaffed) clinics, doctors have to make multiple important decisions every day, often quickly and with complicated or limited information. Decision-making in these circumstances could easily result in analysis paralysis, so heuristics are useful to draw upon past experiences and outcomes to treat the patient, and move on to the next. However, this is also when biases can creep in.

The quality of our decision-making is limited by the amount of time and information used to make them, and when using these cognitive shortcuts, we effectively reduce the accuracy of our judgements. Heuristics are also based largely on the experience of the person making the decision, and so are biased towards situations they have experienced. Decisions bases on reduced accuracy and limited experiences can have a significant impact on the outcome of our behaviour, particularly in a medical setting, so recognising these biases are vital for patient outcomes.

Biases impact patient outcomes

In a medical setting, two common forms of bias that impact decisions are anchoring bias and confirmation bias, and both can affect how long it takes to reach a diagnosis. Anchoring bias is when one symptom or feature is fixated on, to the exclusion of all others. Confirmation bias is similar; it is selectively focusing on evidence that supports the initial diagnosis, minimising or dismissing evidence that might suggest otherwise. So, it is possible an incorrect diagnosis may be investigated and treated for some time before an alternative is considered.

In this way, biases in medicine can directly delay a patient reaching the correct diagnosis, in some cases impacting their outcomes. And this issue reaches further still; biases like this also affect the patients, and how they view their condition and healthcare in general. When symptoms persist despite supposedly having a diagnosis, patients can feel frustrated with the system and dismissed by their doctor.

Minimising impact on patients

So what can we do to minimise the risk of bias in misdiagnoses? Understanding the drivers behind the reliance on heuristics is a key first step, and from here we can begin to design tailored interventions to de-bias the diagnostic journey.

Some interventions are already in place; Multi-disciplinary team (MDT) meetings are an important element of treatment decision-making. In cancer, teams of onocologists, surgeons, clinical nurse specialists, radiologists, and pathologists come together to discuss the diagnoses and treatment of patients, each bringing their experiences, expertise, and opinions to the table. MDT meetings like this occur within most hospital disciplines, helping to ensure all options for treatment are discussed.

Mostly, though, having a diverse team is key, as well as a cluture shift towards staff showing self-awareness by taking the time to understand and challenge their own habits. Both can greatly improve the outcome for patients, and help to promote a more positive relationship with doctors and the healthcare system.