Abstract
Using heuristics offers several cognitive advantages, such as increased speed and reduced effort when making decisions, in addition to allowing us to make decision in situations where missing data do not allow for formal reasoning. But the traditional view of heuristics is that they trade accuracy for efficiency. Here the authors discuss sources of bias in the literature implicating the use of heuristics in diagnostic error and highlight the fact that there are also data suggesting that under certain circumstances using heuristics may lead to better decisions that formal analysis. They suggest that diagnostic error is frequently misattributed to the use of heuristics and propose an alternative view whereby content knowledge is the root cause of diagnostic performance and heuristics lie on the causal pathway between knowledge and diagnostic error or success.
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Asch, S. E. (1955). Opinions and social pressure. Scientific American, 193, 31–35.
Babu, A. J. G., & Suresh, N. (1996). Project management with time, cost, and quality considerations. European Journal of Operational Research, 88, 320–327.
Baron, J., & Hershey, J. C. (1988). Outcome bias in decision evaluation. Journal of Personality and Social Psychology, 54, 569–579.
Barrows, H. S., Norman, G. R., Neufeld, V. R., & Feightner, J. W. (1982). The clinical reasoning of randomly selected physicians in general medical practice. Clinical and Investigative Medicine, 5, 49–55.
Berner, E. S., & Graber, M. L. (2008). Overconfidence as a cause of diagnostic error in medicine. The American Journal of Medicine, 121(Suppl 5), S2–S23.
Bradford-Hill, A. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58, 295–300.
Cherubini, P., & Mazzocco, A. (2004). From models to rules: Mechanization of reasoning as a way to cope with cognitive overloading in combinatorial problems. Acta Psychologica, 116, 223–243.
Coderre, S., Mandin, H., Harasym, P. H., & Fick, G. H. (2003). Diagnostic reasoning strategies and diagnostic success. Medical Education, 37, 695–703.
Croskerry, P. (2003a). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78, 775–780.
Croskerry, P. (2003b). Cognitive forcing strategies in clinical decisionmaking. Annals of Emergency Medicine, 41, 110–120.
Croskerry, P. (2009). A universal model of diagnostic reasoning. Academic Medicine, 84, 1022–1028.
Croskerry, P. (2013). From mindless to mindful practice—cognitive bias and clinical decision making. The New England Journal of Medicine, 368, 2445–2448.
Croskerry, P., & Norman, G. (2008). Overconfidence in clinical decision making. The American Journal of Medicine, 121(Suppl 5), S24–S29.
Crowley, R. S., Legowski, E., Medvedeva, O., Reitmeyer, K., Tseytlin, E., Castine, M., et al. (2013). Automated detection of heuristics and biases among pathologists in a computer-based system. Advances in Health Science Education, 18, 343–363.
Dawes, R. M. (1979). The robust beauty of improper linear models in decision making. American Psychologist, 34, 571–582.
Dieckmann, A., & Rieskamp, J. (2007). The influence of information redundancy on probabilistic inferences. Memory and Cognition, 35, 1801–1813.
Dijksterhuis, A., Bos, M. W., Nordgren, L. F., & van Baaren, R. B. (2006). On making the right choice: The deliberation-without-attention effect. Science, 311, 1005–1007.
Elstein, A. S., Shulman, L. S., & Sprafka, S. A. (1978). Medical problem solving: An analysis of clinical reasoning. Cambridge, MA: Harvard University Press.
Epstein, R. M. (1999). Mindful practice. The Journal of the American Medical Association, 282, 833–839.
Ericsson, K. A. (2006). The influence of experience and deliberate practice on the development of superior expert performance. In K. A. Ericsson, N. Charness, R. R. Hoffman, & P. J. Feltovich (Eds.), The Cambridge handbook of expertise and expert performance. New York: Cambridge University Press.
Gandhi, T. K., Kachalia, A., Thomas, E. J., Puopolo, A. L., Yoon, C., Brennan, T. A., et al. (2006). Missed and delayed diagnoses in the ambulatory setting: A study of closed malpractice claims. Annals of Internal Medicine, 145, 488–496.
Gigerenzer, G., & Gaissmaier, W. (2011). Heuristic decision making. Annual Review of Psychology, 62, 451–482.
Graber, M. (2005). Diagnostic errors in medicine: A case of neglect. Joint Commission Journal on Quality and Patient Safety, 31, 106–113.
Graber, M. L., Franklin, N., & Gordon, R. (2005). Diagnostic error in internal medicine. Archives of Internal Medicine, 165, 1493–1499.
Green, L., & Mehr, D. R. (1997). What alters physicians’ decisions to admit to the coronary care unit? The Journal of Family Practice, 45, 219–226.
Hertwig, R., & Herzog, S. M. (2009). Fast and frugal heuristics: Tools of social rationality. Social Cognition, 27, 661–698.
Hogarth, R. M. (2001). Educating intuition. Chicago Il: University of Chicago Press.
Kachalia, A., Gandhi, T. K., Puopolo, A. L., Yoon, C., Thomas, E. J., Griffey, R., et al. (2007). Missed and delayed diagnoses in the emergency department: A study of closed malpractice claims from 4 liability insurers. Annals of Emergency Medicine, 49, 196–205.
Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus & Giroux.
Kahneman, D., & Klein, G. (2009). Conditions for intuitive expertise: A failure to disagree. American Psychologist, 64, 515–526.
Kirch, W., & Schafii, C. (1996). Misdiagnosis at a university hospital in 4 medical eras. Medicine, 75, 29–40.
Klein, G. (1998). Sources of power: How people make decisions. Cambridge, MA: The MIT Press.
Kulatunga-Moruzi, C., Brooks, L. R., & Norman, G. R. (2004). Using comprehensive feature lists to bias medical diagnosis. Journal of Experimental Psychology. Learning, Memory, and Cognition, 30, 563–572.
Lopez, L. L. (1992). Three misleading assumptions in the customary rhetoric of the bias literature. Theory and Psychology, 2, 231–236.
Lord, K. M. (1998). Entrapment and due process: Moving toward a dual system of defenses. Florida State University Law Review, 25, 463–518.
Mamede, S., van Gog, T., van den Berge, K., Rikers, R. M., van Saase, J. L., van Guldener, C., et al. (2010). Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. The Journal of the American Medical Association, 304, 1198–1203.
Mamede, S., van Gog, T., van den Berge, K., van Saase, J. L., & Schmidt, H. G. (2014). Why do doctors make mistakes? A study of the role of salient distracting clinical features. Academic Medicine, 89, 114–120.
Martignon, L., & Hoffrage, U. (2002). Fast, frugal, and fit: Simple heuristics for paired comparisons. Theory and Decision, 52, 29–71.
Norman, G. R., & Eva, K. W. (2010). Diagnostic error and clinical reasoning. Medical Education, 44, 94–100.
Norman, G., Young, M., & Brooks, L. (2007). Non-analytical models of clinical reasoning: The role of experience. Medical Education, 41, 1140–1145.
Perkins, D. L., & Salomon, G. (1989). Are cognitive skills context-bound? Educational Researcher, 18, 6–25.
Reyna, V. F., & Lloyd, F. J. (2006). Physician decision making and cardiac risk: Effects of knowledge, risk perception, risk tolerance, and fuzzy processing. Journal of Experimental Psychology: Applied, 12, 179–195.
Sackett, D. L. (1979). Bias in analytic research. Journal of Chronic Diseases, 32, 51–63.
Schmidt, H. G., Mamede, S., van den Berge, K., van Gog, T., van Saase, J. L., & Rikers, R. M. (2014). Exposure to media information about a disease can cause doctors to misdiagnose similar-looking clinical cases. Academic Medicine, 89, 285–291.
Shanteau, J. (1992). How much information does an expert use? Is it relevant? Acta Psychologica, 81, 75–86.
Sherbino, J., Dore, K. L., Wood, T. J., Young, M. E., Gaissmaier, W., Kreuger, S., et al. (2012). The relationship between response time and diagnostic accuracy. Academic Medicine, 87, 785–791.
Sherry, D. F., & Schacter, D. L. (1987). The evolution of multiple memory systems. Psychological Review, 94, 439–454.
Sloman, S. A. (1996). The empirical case for two systems of reasoning. Psychological Bulletin, 119, 3–22.
Smith, E. R., & DeCoster, J. (2000). Dual-process models in social and cognitive psychology: Conceptual integration and links to underlying memory systems. Personality and Social Psychology Review, 4, 108–131.
Todd, P., & Gigerenzer, G. (2001). Putting naturalistic decision making into the adaptive toolbox. Journal of Behavioral Decision Making, 14, 381–383.
Tversky, A., & Kahneman, D. (1974). Judgement under uncertainty: Heuristics and biases. Science, 185, 1124–1131.
Yi, S. K., Steyvers, M., Lee, M. D., & Dry, M. J. (2012). The wisdom of the crowd in combinatorial problems. Cognitive Science, 36, 452–470.
Yopchick, J. E., & Kim, N. S. (2012). Hindsight bias and causal reasoning: A minimalist approach. Cognitive Processing, 13, 63–72.
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McLaughlin, K., Eva, K.W. & Norman, G.R. Reexamining our bias against heuristics. Adv in Health Sci Educ 19, 457–464 (2014). https://doi.org/10.1007/s10459-014-9518-4
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DOI: https://doi.org/10.1007/s10459-014-9518-4