Use of heuristics during the clinical decision process from family care physicians in real conditions
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Fernández Aguilar, Carmen; Martín Martín, José Jesús; Minué Lorenzo, Sergio; Fernández Ajuria, AlbertoEditorial
Wiley-Blackwell Publishing
Materia
Heuristics Health economics Medical error
Date
2021-08-09Referencia bibliográfica
Fernández-Aguilar, C... [et al.]. Use of heuristics during the clinical decision process from family care physicians in real conditions. J Eval Clin Pract. 2021; 1- 7. [https://doi.org/10.1111/jep.13608]
Sponsorship
Health Research Fund of the Ministry of Economy and Competitiveness PI13/01175 PI10/01468Abstract
Rationale aims and objectives: The available evidence on the use of heuristics and
their relationship with diagnostic error in primary care is very limited. The aim of the
study is to identify the use of unknown thought and specifically the possible use of
Representativeness, Availability and overconfidence heuristics in the clinical practice
of primary care physicians in cases of dyspnoea and to analyse their possible relationship
with diagnostic error.
Methods: A total of 371 patients consulting with new episodes of dyspnoea in
Primary Care centres in Spain were registered. Based on specific operational definitions,
the use of unconscious thinking and the use of heuristics during the diagnostic
process were assessed. Subsequently, the association between their use and diagnostic
error was analysed.
Results: In 49.6% of cases, the confirmatory diagnosis coincided with the first diagnostic
impression, suggesting the use of the representativeness heuristic in the diagnostic
decision process. In 82.3% of the cases, the confirmatory diagnosis was among
the three diagnostic hypotheses that were first identified by the general physicians,
suggesting a possible use of the availability heuristic. In more than 50% of the cases,
the physicians were overconfident in the certainty of their own diagnosis. Finally, a
diagnostic error was identified in 9.9% of the recorded cases and no statistically significant
correlation was found between the use of some unconscious thinking tools
(such as the use of heuristics) and the diagnostic error.
Conclusion: Unconscious thinking manifested through the acceptance of the first
diagnostic impression and the use of heuristics is commonly used by primary care
physicians in the clinical decision process in the face of new episodes of dyspnoea;
however, its influence on diagnostic error is not significant. The proposed explicit
and reproducible methodology may inspire further studies to confirm these results.