Reviewing intuitive decision-making and uncertainty: the implications for medical education

Authors


Katherine Hall, Senior Lecturer and Senior Research Fellow, New Zealand Health Technology Assessment, Christchurch School of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand. Tel./Fax: 00 64 3 364 1152; E-mail: katherine.hall@chmeds.ac.nz

Abstract

Context

Intuition and uncertainty are inescapable conditions of many instances of clinical decision- making. Under such conditions biases and heuristics may operate, distorting the decision-making process. Physicians and students are generally unaware of these influences.

Purpose

To review the extant literature regarding the role of uncertainty and intuition and associated biases on medical decision-making, to highlight the implications this holds for medical education.

Content

Using literature identified via Medline and Bioethicsline searches of the past 3 decades, this paper reviews the sources of uncertainty in clinical practice and the role of intuitive decision-making. A detailed description of associated heuristics and biases is provided, and linked with demonstrable examples from medical decision-making.

Conclusions

It is argued that although uncertainty can be reduced, it can never be completely eliminated from decision-making. Therefore most decision-making performed in medicine contains an irreducible intuitive element and is thus vulnerable to these biases and heuristics. Given that few medical curricula overtly address the process of medical decision-making, both medical students and physicians remain vulnerable to these effects on their own (and their patients') decision-making. Insight via education appears the major means in which to avoid distorting decision-making processes.

Ancillary