Doctor bias may lead to low-value interventions

Doctors should be aware that psychological factors could lead them to suggest medical interventions of little or no value to patients, according to a review on clinical decision-making published in the Medical Journal of Australia.

The review was led by University of Queensland (UQ) Associate Professor Ian Scott, who is also director of internal medicine and clinical epidemiology at the Princess Alexandra Hospital. According to Dr Scott, much of everyday clinical decision-making is intuitive and could be influenced by bias.

“In most situations this intuition generates the correct decision, but in some circumstances doctors can fall prey to cognitive biases which generate the wrong decision,” he said.

“These cognitive biases, or psychological factors that influence thinking, can come from formal education and training and from peer opinion, personal experience, societal norms and from socialising with colleagues.

“These biases … can steer clinicians towards continuing to believe in, and deliver, care that robust evidence has shown to confer little or no benefit.

“It may also cause patient harm or yield marginal benefits at a disproportionately high cost.”

National campaigns such as Choosing Wisely Australia and EVOLVE aim to reduce the frequency of low-value interventions. But the review finds that the effectiveness of such campaigns could be limited by common forms of cognitive bias.

“For example, a clinician might remember the case of Patient X who did very well with a particular treatment despite all the odds and then, in future, go on to treat every other patient with a similar presentation in a similar way, even though for many this may not be the most appropriate form of care,” Dr Scott said.

“To take out the bias, the clinician should question whether he or she would expect to see the experience of Patient X repeated again based on the law of averages, or was it really a one-off.”

According to Dr Scott, sharing case studies of what could be seen in hindsight as low-value care with colleagues, and disclosing one’s reasoning for such decisions, could help expose and reduce cognitive bias. He noted that further research is needed.