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When can heuristics in healthcare become a problem?

The term "by the book" implies that there is one correct way to accomplish a task, whether that be replacing an air filter or preparing your taxes. You might think the same standard applies to healthcare, and in many situations, it does. There are generally accepted standards of care in each clinical field that help to guide the clinicians delivering care to you and other Carnegie residents. Unfortunately, your body is somewhat more complex than a car or a tax form, and thus healthcare providers are also relied upon to think on their feet when the situation calls for it. The question then becomes are they willing to do so? 

Heuristics is the term applied to established standards within a given industry. These are the unofficial "rules of thumb" that experience and expertise implies that service providers should follow. However, an unwavering acceptance of heuristics as the only way to work can be problematic (particularly in healthcare). The Agency for Healthcare Research and Quality has identified the following forms of cognitive bias that can arise when clinicians rely too heavily on heuristics: 

  • Premature closure: Basing opinion on initial impressions despite subsequent indicators suggesting the contrary
  • Framing effects: Allowing external information (such as a patient's demographic information) to influence opinions
  • Availability heuristic: Forming opinions based primarily on recent trends
  • Blind obedience: Adhering to expert opinion above all else

Relying on rules of thumb in each of these situations could produce negative results due to the fact that they all discount what should be the most important factor in your treatment: clinical indications. Those are what your doctor should be using when formulating your care plan. Heuristics should instead be viewed from the prospective of how they can support your care, not influence it. 

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