Day 139

Good decision-making involves proper awareness of a situation and then choosing a course of action. If the awareness is inaccurate the decisions taken will most likely be incorrect. In high-risk fields of work, such as medicine, this can mean the difference between life and death.

Thinking about how we think is one kind of ‘Critical thinking’. More often than not we are unaware that we have biases, which greatly affect our ability to make decisions.

1. Action-Oriented Bias

This makes us take an action believing in a positive outcome and completely dismissing the possibility of a negative result or a chance occurrence. We are overconfident in our ability to influence events positively.

Example: “This is not the first time I am treating this condition. The last time I did this it worked so it is bound to do the same this time (and of course “I know best”)”.

2. Self-Interest Bias

When the wrong behaviour is incentivised due to conflict of interests, it is easy to get it wrong.

Example: “my surgery saves money if I don’t refer patients to specialist services”. Or, “If I ask for help I might look silly” – very common amongst some senior doctors.

Silo thinking is not considering the bigger picture or other stakeholders. In this case educating the carers and paying attention to their inputs was not considered important.

3. Pattern-Recognition Bias

We look for and see patterns where they don’t exist and give more weight to recent or to highly memorable events. Once we have formulated a theory, we pay more attention to items that support it and ignore evidence that disproves it.

Example: A belief in the myth that directly questioning a depressed patient about suicidal ideation makes them actually think about it.

4. Social Harmony Bias

Maintaining the status quo, not rocking the boat and not alerting the relatives about warning signs and possible outcomes.

In the absence of proper training or significant self-awareness it is easy to fall into these biases with tragic results.  It would seem that the necessary training is not widely available with respect to mental health in the UK National Health Service.

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