Choosing Wisely?

The ‘Choosing Wisely’ Campaign is led by the American Board of Internal Medicine (ABIM) Foundation and Consumer Reports and hopes to cultivate meaningful conversations between clinicians and patients about avoiding unnecessary medical tests, treatments, and procedures. 

The greatest challenge to its success is its failure to consider the cognitive biases shaping clinician behaviour.   According to authors of a MAJ narrative review, most day-to-day clinical decisions are made intuitively, meaning they are subject to these biases.  Professor Ian Scott and his team at Princess Alexandra Hospital have identified several of the most common examples.  Let’s take a look at 3 of them.

-Commission Bias refers to clinicians’ innate desire to avoid regret by failing to perform an intervention that could have helped a few patients.  This can cause some clinicians to spend exorbitant amounts on patients on end-of-life care who may receive little benefit in terms of longevity and quality of life.  

-Impact Bias refers to the overestimation of benefits compared to the negative consequences of intervention.  While this can lead clinicians to exhaust every treatment option, the patient may ultimately end up worse off financially, physically, and emotionally.

-Sunken-Cost Bias refers to continuing a treatment path despite potential harm or inappropriate care due to time and resources already invested.  Sometimes, we get our heads wrapped around one idea and can’t let it go.  This can be detrimental to patients when our thinking becomes rigid and can increase the emotional and financial impact on patients and their families. 

Since decision-making is not as rational as you might have imagined, there are many more points of leverage to encourage clinicians to provide optimal care to their patients.  Check out the article for a full list of the most common biases encountered in clinical decision-making.