For instance, in environments with a lower risk of being sued, doctors may rely on different medical heuristics. In Switzerland, where litigation is less common, only 41% of general practitioners and 43% of internists reported that they sometimes or often recommend a PSA test for legal reasons.13 Past research on fast-and-frugal heuristics The heuristics in the adaptive toolbox can be classified along several nonexclusive categories. These categories include:
(i) how the heuristic processes information (eg, assigning Inhibitors,research,lifescience,medical different importance to different predictor variables by ordering them sequentially, as in Figure 1); (ii) whether the heuristic is applicable to the social domain (eg, to doctor-patient interactions or bargaining Inhibitors,research,lifescience,medical at the bazaar); (iii) whether the heuristic is a model of inductive inference about unknown quantities and future events (eg, in medical diagnosis or weather forecasting); or (iv) whether the heuristic represents a model for decisions that are based exclusively on the contents of one’s memories (eg, in quiz shows or under time pressure in a medical emergency). Corresponding models of heuristics have been studied in diverse domains, including applied ones, such as enforcing proenvironmental behaviour or forecasting Inhibitors,research,lifescience,medical customers’ activities in business, as well as in the basic sciences,
ranging from animal behavior to the law, finance, or psychology.14,15 At the same time, a number of heuristics for very different Inhibitors,research,lifescience,medical tasks have been proposed: heuristics for mate search,16 inferences about politicians,17 and choices between risky alternatives,18 to name a few. In the applied world, heuristics have been used to predict, for example, the performance of stocks,19 the outcomes of sports competitions,20 or the results of political elections.21 Heuristics in health care? Although the science of fast-and-frugal heuristics has started to make an impact in the medical community,22 Inhibitors,research,lifescience,medical the heuristics-and-biases perspective still Blebbistatin mw dominates as of today.23 For instance, Elstein24 refers to heuristics as “mental shortcuts commonly used in decision making that can
lead to faulty reasoning or conclusions” (p 791), citing them as a source of many errors in clinical Thymidine kinase reasoning. Some medical researchers, however, recognize the potential of fast-and-frugal heuristics to improve decisions. For example, as McDonald25 writes, “admitting the role of heuristics confers no shame” (p 56). Rather, the goal should be to formalize and understand heuristics so that their use can be effectively taught, which could lead to less practice variation and more efficient medical care. Similarly, Elwyn et al26 state that “The next frontier will involve fast-and-frugal heuristics; rules for patients and clinicians alike” (p 574). In what follows, we will discuss different ways in which the study of heuristics can inform medical decision making.