Cognitive processes1/10/2024 Then, pattern-matching is used to identify features of the case, or “pivots” that stand out, are unique, or do not fit. As an example, prolonged hypotension, lactic acidosis, and hepatic failure may be aggregated into a composite “feature” of the case (inadequate end-organ perfusion). 31, 32 In this approach, physicians begin by aggregating clinical observations into groups to reduce their number. This decision model, developed to cope with limited statistical information, is the classic “case conference” approach taught in medical school, and leverages the remarkable human ability to identify by pattern-matching. Note that EU theory assumes complete probabilistic knowledge of all potential choices, the payoffs associated with each choice, and a well-organized and consistent ordering of preferences for each payoff. According to EU theory, the human should choose the first gamble due to the larger EV. The first would pay $2 for getting “heads” but nothing for “tails.” The second would pay $1 for heads and $0.50 for tails. As an illustration, consider a choice between two gambles involving a coin toss. 23, 24 Developed in the 17th century, the EU model argues that humans decide among a set of choices by calculating the expected benefit from each choice (multiplying the probability of the outcome resulting from each choice by the payoff for that outcome) and selecting the option with the highest “expected value” (EV). The longest lived and most widely accepted formal model of rational decision making is termed “expected utility” (EU). This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision making. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Īlthough the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. Many nonrational ( i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. These observations have increased interest in understanding decision-making psychology. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. The quality and safety of health care are under increasing scrutiny.
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