The readings on heuristics and biases helped me identify the root of potential flaws in human decision making. The biases that Tversky and Kahneman describe under “Representativeness” alone were enough to make me stop and think about various scenarios in which these biases can result in compromised patient care through poor assessment and diagnosis. For example insensitivity to sample size and misconceptions of chance can influence how we perceive statistics and the likelihood of outcomes. The article also describes insensitivity to predictability and the illusion of validity. Nurses can be influenced by a patient who is younger or appears physically fit, stoic, or is described favorably or positively by a previous practitioner instead of making a completely objective assessment. As a result, diagnoses can be delayed or incorrect. The remaining biases that were discussed that concern availability and adjustment and anchoring can also influence nursing decision in many aspects of daily work.
I feel that although years of experience can assist nursing in accelerated and more precise decision making, nurses must be aware of the potential of these innate biases to influence accuracy in decision making regarding patient care. Thompson (2003) discusses overconfidence which in my opinion can be more problematic as years of experience accumulate. I didn't give much thought to clinical decision support systems until now. I assumed that they were merely a short cut and a convenience. After researching one in detail and gaining an understanding of human biases and heuristics, I have come to appreciate their value as useful and important tools in health care.
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I think the biases and heuristics discussed by Tversky and Kahneman are very true. I work in a Pediatric ICU where we see patients from a very large geographic location including Nevada, Utah, Wyoming, Montana, and Idaho. I think because of this and seeing the sickest of the sick that sometimes judgments and biases are made on past experience and "quick" diagnoses are provided. Making a complete head to toe assessment individually for each instance is imperative. Recently, we had a child admitted who has chronic health concerns. Assumptions were made based on past medical history and occurrences at the hospital. Because of that, a significant misdiagnosis was made that delayed treatment for a certain ailment. Generalizations were made and biases were strong. It is a good lesson for all that we need to approach each patient and situation individually using evidence based practice. I think in this situation a CDSS might have led the physicians and NPs to the additional diagnosis sooner.
ReplyDeleteOverconfidence is also an issue in many situations. How many times have you heard someone state that they have seen "this situation" a hundred times and they are "positive" that this patient fits that picture? The hard part is that many times this is the case, however, there are those who are misdiagnosed and improper treatments initiated because of it. I agree with Thompson (2003) that overconfidence is an issue and as you have said many times is problematic for those with more experience.