Contends that many Americans make irrational decisions about
crucial medical care and choose treatments not in their best interest.
Presents, in chart form, a good guide to bad thinking. Decision-making
behavior includes categorization, prediction, hindsight bias, and more;
Definition; Example; Potential hazard; Reported by Donald A. Redelmeier,
M.D. and colleagues in the 'Journal of the American Medical Association'
(Vol. 270., No. 1).
By
PT Staff, published on November 01, 1993
MEDICAL DECISION-MAKING
The mind works in mysterious ways. When forced to make crucial
decisions about medical care, many Americans rely on techniques to
evaluate possible risks and benefits that are actually quite irrational.
As a result, they often choose treatments that may not be in their best
interest, report Donald A. Redelmeier, M.D., and colleagues in the
Journal of the American Medical Association (Vol. 270, No. 1). Herewith,
a good guide to bad thinking.
DECISION-MAKING BEHAVIOR:
Categorization
DEFINITION:
Viewing a treatment as either completely dangerous or entirely
safe.
EXAMPLE:
Believing that if taking a little vitamin C is good, taking a lot
must be better.
POTENTIAL HAZARD:
Not recognizing that treatments have varying effects at different
levels of exposure. In large quantities, for example, vitamin C can cause
kidney stones.
DECISION-MAKING BEHAVIOR:
Prediction
DEFINITION:
Choosing between alternatives by imagining how the available
choices will feel.
EXAMPLE:
Gauging a reaction to colostomy by predicting comfort levels
immediately after the operation.
POTENTIAL HAZARD:
Attitudes about a treatment often change with time and cannot
always be accurately anticipated, especially when patients are unfamiliar
with the procedure.
DECISION-MAKING BEHAVIOR:
Hindsight bias
DEFINITION:
Examining past decisions by highlighting data consistent with the
outcome, and deemphasizing data that is contradictory or
ambiguous.
EXAMPLE:
Classifying a medical decision as a mistake if it was followed by
significant adverse consequences.
POTENTIAL HAZARD:
Patients who Monday-morning quarterback may make unduly negative
evaluations about treatments that are actually quite sound.
DECISION-MAKING BEHAVIOR:
Preferring the status quo
DEFINITION:
Unwillingness to accept a loss in one dimension of life to achieve
an improvement in another.
EXAMPLE:
Studies show that dipyridamole is ineffective at preventing
strokes, yet many patients with cerebrovascular disease taking this drug
refuse to stop.
POTENTIAL HAZARD:
People who are reluctant to relinquish current routines may have
difficulty making healthful lifestyle changes--e.g., exercising
regularly, driving carefully, eating a low-fat diet.
DECISION-MAKING BEHAVIOR:
Worry management
DEFINITION:
Avoiding situations and information that may cause anxiety.
EXAMPLE:
Women who are afraid to seek medical attention after detecting a
lump in their breast.
POTENTIAL HAZARD:
Continually steering clear of worrisome situations not only affects
quality of life but also deprives people of the advantages of early
treatment.
DECISION-MAKING BEHAVIOR:
Reliving past experiences
DEFINITION:
Choosing a previously experienced medical treatment on the basis of
inaccurate or distorted memories.
EXAMPLE:
Remembering a procedure that causes only a few days of intense
acute pain as more unpleasant than one that produces months of moderate
chronic pain.
POTENTIAL HAZARD:
Memories are subject to error, patients who rely on them may be
surprised by what they eventually experience. While shorter treatments
may entail a smaller loss in quality of life, productivity, and
well-being, they are often more potent and aversive than longer
ones.
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