Enhancing Medical Decision Making When Caring for the Critically Ill: The Role of Cognitive Heuristics and Biases

The foundations of human judgment and decision theory have influenced studies on decision making for decades in various domains. A specific area of human judgment is decision-making under conditions of uncertainty. Medicine is an example of decision-making under conditions of uncertainty where doctors constantly make decisions with incomplete information, knowledge gaps and sometimes with inaccurate information. These conditions are exacerbated in critical care environments (Emergency Departments (ED) and Intensive Care Units (ICU)) which are complex in nature with information intensive, time sensitive, highly stressful, non-deterministic, interruption-laden, and life-critical [1]. Caring for critically ill patients within these situations often requires clinicians to make life-and-death decisions within a few seconds while relying on large quantities of questionable information. In order to make these decisions in a timely manner, the clinician must reduce the large quantity of data to a manageable dimension and quickly determine what information is critical to handle the current situation [2]. Studies have shown that individuals often deal with such situations by using cognitive heuristics, or mental shortcuts [1, 2]. Even though the use of heuristics can lead to appropriate judgments, inappropriate heuristic use can result in severe and systematic errors [3–5]. In medicine, such errors include incorrect or delayed diagnosis, and inappropriate or delayed treatment, all of which can result in adverse medical events and patient harm. Due to the severe consequences of medical errors, it is imperative to minimize inappropriate use of cognitive heuristics by developing techniques to identify cognitive heuristic use.