Rationality in medical decision making: a review of the literature on doctors’ decision-making biases


  • * A considerable proportion of this literature employs non-medical participants who are asked to make medical judgements (i.e. diagnostic or treatment decisions) for hypothetical cases (e.g. Klayman & Brown 1993; Medin et al. 1982). Although such simulations are very helpful at uncovering general decision-making principles, we limit our discussion to studies in which participants have at least some medical training (i.e. medical students, residents or practising doctors). In focusing on common biases, we also do not consider differences across doctors varying in expertise, although we note that some research indicates that more experienced doctors do exhibit less bias (e.g. Dawson et al. 1988; Elstein et al. 1978).

Correspondence: DrBrian H.Bornstein 238 Burnett Hall, Department of Psychology, University of Nebraska, Lincoln, NE 68588-0308 USA


The objectives of this study were to describe ways in which doctors make suboptimal diagnostic and treatment decisions, and to discuss possible means of alleviating those biases, using a review of past studies from the psychological and medical decision-making literatures. A number of biases can affect the ways in which doctors gather and use evidence in making diagnoses. Biases also exist in how doctors make treatment decisions once a definitive diagnosis has been made. These biases are not peculiar to the medical domain but, rather, are manifestations of suboptimal reasoning to which people are susceptible in general. None the less, they can have potentially grave consequences in medical settings, such as erroneous diagnosis or patient mismanagement. No surefire methods exist for eliminating biases in medical decision making, but there is some evidence that the adoption of an evidence-based medicine approach or the incorporation of formal decision analytic tools can improve the quality of doctors’ reasoning. Doctors’ reasoning is vulnerable to a number of biases that can lead to errors in diagnosis and treatment, but there are positive signs that means for alleviating some of these biases are available.