Using evidence and logic in everyday clinical reasoning, communication and legal and scientific argumentation
Milos Jenicek in Foundations of Evidence-Based Medicine, 2019
A cognitive error or cognitive bias (terms often used interchangeably across the literature) denotes a pattern of deviation in judgment that occurs in particular, within our area of interest, in medical and clinical situations or in medical research reasoning and conclusions.10,22 For example, ‘hindsight bias’ (loosely synonymous with outcome bias) is a cognitive error as well. It is a tendency for people with outcome knowledge to exaggerate the extent to which they would have predicted the event beforehand. Bias as it is used currently across the medical literature has multiple meanings including almost any flaw in reasoning and decision-making, especially in medical research (research design, execution and evaluation). It is increasingly discussed because even ‘biased’ research results and their uses may be detrimental to patient safety and health. In this context, bias is in a great part synonymous with fallacy.
Making Sense of Behaviour
Cathy Laver-Bradbury, Margaret J.J. Thompson, Christopher Gale, Christine M. Hooper in Child and Adolescent Mental Health, 2021
The cognitive-behaviour model assumes that behaviour can be explained by the individual’s beliefs and emotions and that any understanding of a particular behaviour necessitates the understanding of the thoughts and feelings linked to that particular behaviour. Thoughts and emotions respond to their own processes that cognitive psychologists can describe and influence. Thought processes, e.g. cognitive bias, that is common errors in thinking, offer plausible explanations of why most people will readily absorb information that confirms existing beliefs whilst ignoring the information that questions it. This in turn explains feelings and behaviours associated with those beliefs. Variations of these, mostly well-understood cognitive processes, can be used to inform our understanding of psychiatric conditions. One variation of confirmation bias explains how people who are feeling low will focus on negative thoughts and events and ignore positive ones, leading to further low mood and depression.
Controversies in Statistical Science
Mark Chang, John Balser, Jim Roach, Robin Bliss in Innovative Strategies, Statistical Solutions and Simulations for Modern Clinical Trials, 2019
We often wish to have a direct answer to the question of the effectiveness of a drug or a clinical intervention. To this end, we can use Bayesian posterior probability, which is a combination of prior knowledge and current experimental data. One common criticism of the Bayesian method is its subjectivity in determining prior knowledge. Such subjectivity combined with a psychological bias, such as anchoring, makes the result more controversial (Lench, Safer, Levine, 2011). Anchoring is a cognitive bias that describes the common human tendency to rely too heavily on the first piece of information offered (the “anchor”) when making decisions. We are constantly using the Bayesian notion of learning or reasoning in our scientific research and our daily lives, because every conscious action we take is a utilization of prior relevant experiences or knowledge. The determination of the prior probability is essentially an application of the similarity principle that suffers the same subjectivity issue that affects the determination of a similarity set.
Healthcare Decisions Are Always Supported Decisions
Published in The American Journal of Bioethics, 2021
To begin, one need not be at the margins of autonomy to be a flawed decision-maker. As elucidated by John Doris (2009, 2015), the basis for an individual’s decision are often irrelevant factors, not the result of deliberating on considerations, values, and reasons. Without conscious awareness, it has been shown that posters with watching eyes in them affect people’s behavior for rule following; or in the case of ego depletion, an individual’s resistance to temptation, e.g. eating a piece of chocolate cake, depends on how long they had been avoiding another temptation, e.g. sitting in a room with cookies all day (Doris 2009, 2015). Yet even when consciously aware and actively deliberating, cognitive biases result in flaws of an individual’s decision-making, e.g. people are more likely to choose something when framed as a loss rather than a gain (Kahneman 2011).
Using an experiential learning model to teach clinical reasoning theory and cognitive bias: an evaluation of a first-year medical student curriculum
Published in Medical Education Online, 2023
Justin J. Choi, Jeanie Gribben, Myriam Lin, Erika L. Abramson, Juliet Aizer
Evidence demonstrating the effectiveness of educational interventions focused on raising awareness of reasoning and cognitive biases has been limited[55]. However, experimental studies in psychological sciences have shown that debiasing-training interventions can have long-lasting effects on improving decision making, including among graduate students [56,57]. Cognitive debiasing occurs through a succession of stages from precontemplation, to awareness and the ability to detect bias, to the decision to change, then initiation of strategies to accomplish and maintain the change[58]. Lack of awareness is one factor that may explain the difficulties in mitigating cognitive biases. Raising awareness of cognitive biases in the first year of medical school has several potential benefits: it extends the overall time that students can develop their knowledge, skills, and attitudes on cognitive biases longitudinally; it provides dedicated time for students to focus on developing these skills and perspectives before the competing demands and cognitive load on clerkships; it provides the opportunity for students to see the relevance of cognitive biases in subsequent material and clinical encounters; and it allows students to practice with an experiential learning model that routinely involves reflection, conceptualization, and planning for the next encounter.
Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research
Published in Canadian Journal of Pain, 2023
Louise V. Bell, Sarah F. Fitzgerald, David Flusk, Patricia A. Poulin, Joshua A. Rash
Providers reported concerns over patient adverse effects, physical tolerance, and addiction. Moreover, experiencing or witnessing negative patient-related salient events (e.g., patients who have overdosed) and provider-related salient events (e.g., threat to provider) contributed to hesitancy surrounding prescribing opioids to manage pain. Salient negative events can result in cognitive biases that impact the delivery of medical care,61,62 such as availability63 and representativeness biases.64 Cognitive behavioral techniques could be beneficial for highlighting cognitive biases. For example, cognitive restructuring could be used to acknowledge distorted thoughts and promote reasoned practice.65 Incorporating cognitive bias awareness into the curriculum at medical centers has yielded promising results, demonstrating that residents were able to recognize biases and create strategies to avoid biased reasoning.66–68 Given associations between chronic opioid use and an increased risk for opioid use disorder, overdose, and death,69–72 it is difficult to interpret whether concerns over adverse effects represent an accurate appreciation for potential opioid-related harms or relative risk aversion.
Related Knowledge Centers
- Bounded Rationality
- Cognitive Dissonance
- Illusory Correlation
- Irrationality
- Heuristic
- Social Psychology
- Conjunction Fallacy
- Decision-Making
- Sunk Cost
- Egocentric Bias