Biases in medical decision making

Many researchers have studied good clinical reasoning, pointing out that physicians often fail in this. For some authors physicians often make mistakes because they unknowingly fail to observe the laws of formal logic and their reasoning becomes influenced by contextual factors. The medical decision may be considered fundamentally biased since the use of judgment heuristics and a combination of cognitive-related and system-related factors limits physicians' rationality. 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. Nonetheless, they can have potentially serious consequences in medical settings, such as a misdiagnosis or patient mismanagement. Doctors' reasoning is vulnerable to a number of biases that can lead to errors in diagnosis and treatment, but means for alleviating these biases are available. In this chapter the reader is introduced to basic concepts of medical decision making as well as the most studied heuristics and biases in this domain. In the second section of the chapter debiasing techniques are also described, revealing their strengths and weaknesses. While traditional understanding of clinical reasoning has failed to consider contextual factors, most debiasing techniques seem to fail in promoting sound and safer medical practices. Technological solutions, being data-driven, are fundamental in increasing care safety, but they need to consider human factors. Thus balanced models, cognitive-driven and technology based are needed in day-to-day applications to actually improve the clinical decisions.