Cognitive biases in medical education — and in personal decision making.
In my recent blog, Thoughts About Thinking, Dec.16, I quoted Jerome Groopman’s 2007 best-selling book, How Doctor’s Think. He was asking questions of doctors that I then asked of you in that blog. In the 2008 paperback edition, Groopman has written an Afterword that I just read. That reading is the cause of this blog.
Groopman suggests that most misguided medical care resulted from thinking errors rather than technical mistakes. He concluded that: Medical education, for studentsand licensed physicians, had not yet incorporated the emerging science of cognition. Now is the time to integrate that discipline. I believe now is also the time to incorporate the science of cognition, and its cognitive biases, into the discipline of decision making.
Groopman reported that his past misdiagnoses embodied three cardinal cognitive pitfalls.Anchoring error, the common human tendency to rely too heavily, or “anchor,” on one trait or piece of information when making decisions. Attribution error, the inclination to overemphasize the influence of a human’s dispositional factors like individual personality traits, temperament, and genetics, while ignoring the influence of situational factors of a person’ behavior. Availability error, the reliance on those things that we immediately think of to enable quick decisions and judgements, rather than in logic or careful analysis.
These cognitive pitfalls are related to the personal cognitive biases of confirmation bias, self-serving biasand expectancy bias. I have frequently urged us to get better acquainted with our cognitive biases. Groopman says a question often asked of health care professionals: How to find time to think about thinking when working against the clock? The rest of us usually aren’t working against the clock, but do we take time to think about our thinking before deciding?
Doctors diagnosing symptoms and prescribing a remedy is like our decision making process: determining the option to choose in order to achieve the desired outcome. Doctors are not the only ones capable of misdiagnosis, thinking errors and cognitive biases. You and I, and all professionals and all politicians are also susceptible.
It is interesting that this Afterword by Groopman was written in ten years ago. Do you think We the People, Professionals or Politicians today are well acquainted with the science of cognition and cognitive biases? Who will take time to think about thinking?
We can be blind to the obvious, and we can also be blind to our blindness.
Daniel Kahneman, author of Thinking Fast And Slow, 2011