Clinical Decision Making

1. Clinical Decision Making • Clinicians are prone to a wide range of cognitive errors and biases in clinical judgment situations. • Only by being aware of this susceptibility and taking steps to address it can a clinician be as effective a decision maker as possible. • Decision aids – be they actuarial formulas, treatment manuals, etc., are an effective means of limiting such bias and error.

2. Clinical Versus Actuarial Prediction • Two approaches to making decisions: • Reliance on clinical “expertise” and intuition. • This is by far the preference of clinicians • Practitioners tend to have strong belief in the value of their own experience • Use of actuarial decision aids • Use of formula based on empirically established relations • Note – such formula don’t exclude clinician judgments if those judgments have value

3. Clinical Versus Actuarial Prediction • Meehl (1954) first raised the issue and established conditions for fair comparisons • More than 100 studies to date • Evidence overwhelmingly favors actuarial approaches. • Experienced clinicians are no more accurate than novices

4. Why Don’t Clinicians Develop the Expertise They Believe They Have • So why doesn’t experience bring much improvement in clinical judgmental accuracy? • Cognitive biases and errors (universal to human beings – not specific to clinicians) • Such biases and errors are often a result of relying on judgment heuristics (shortcuts) that often work well in everyday life, but which may lead to errors in clinical judgment • Such errors are most likely under conditions of INFORMATION OVERLOAD • Information overload: situation in which there is a large amount of information and no way to determine what is important and what is not • Precisely the situation in clinical assessment

5. A Sampling of Important Cognitive Biases and Errors • Confirmatory Bias - a tendency to search for or interpret new information in a way that confirms one's preconceptions and avoid information and interpretations which contradict prior beliefs. • Illusory Correlation - the phenomenon of seeing the relationship one expects in a set of data even when no such relationship exists. • Availability Bias - a biased prediction, due to the tendency to focus on the most salient and emotionally-charged outcome.

6. A Sampling of Important Cognitive Biases and Errors (cont.) • Hindsight Bias - the inclination to see past events as being predictable. • Overpathologizing Bias – a tendency to assume the presence of pathology (similar to confirmatory bias) • Overconfidence - the tendency to overestimate one's own abilities