Assessing awareness of heuristic medical decision-making in specialized physicians

Abstract

Background: Heuristics, characterized as direct, concise, and often intuitive decision-making strategies, whether consciously or unconsciously employed, play a pivotal role in facilitating swift and efficient choices. Their utilization within clinical decision-making is particularly compelling, given the necessity for prompt and accurate judgments in the medical domain, which frequently entail substantial risk. This study sought to elucidate the intricate relationship between self-reported heuristic use and objective performance in tasks that invoke intuitive cognitive processes. Methods: This research involved the participation of 162 Greek physicians from various specialties in pathology and surgery (Ν = 110 males, age range = 30 to 72 years (M = 46.8 years, SD = 9.81), representing diverse specializations in pathology and surgery. The researchers developed and validated the “Heuristics in Medical Decision-Making Questionnaire” (HMDM) to assess participants’ subjective reports concerning the frequency of heuristic application. Objective assessments involved four Hypothetical Scenarios and the Cognitive Reflection Test. Results: The exploratory factor analysis of the HMDM revealed two distinct factors: one relating to heuristics associated with overconfidence/confirmation and the other with anchoring/availability heuristics, displaying satisfactory reliability metrics. Despite physicians reporting infrequent use of heuristics, the objective task data revealed a substantial reliance on intuitive thinking in medical decision-making. Furthermore, a multivariate analysis of variance demonstrated that the factor of age group significantly affected the employment of overconfidence/confirmation heuristics among the physicians. However, the associations between scores derived from subjective and objective measures did not yield statistically significant correlations. The findings suggest several potential explanations for this disparity, including potential social desirability biases influencing responses on self-report measures such as the HMDM, as well as a general lack of awareness regarding the cognitive underpinnings of decision-making. Conclusions: In conclusion, this research highlights the imperative need for meticulous instruments to evaluate heuristic usage among physicians. Such tools will contribute to targeted interventions aimed at enhancing physicians’ metacognitive awareness when navigating the intricate landscape of medical decision-making.

Keywords

• heuristics
• assessment
• medical decision-making
• intuitive thinking