Research from the Medical Journal of Australia shows doctors are prescribing treatments that are unnecessary or do little to enhance patient care, sometimes to the detriment of their patients.
Doctors’ biases can lead them to make poor clinical decisions resulting in poor patient care, says a new review of evidence in today’s Medical Journal of Australia.
The review says many clinical decisions are based on intuitive behaviours guided by personal instinct that steer clinicians to deliver care that evidence shows to be of low value.
Low value healthcare is care that offers little or no benefit, may cause patient harm, is not aligned with patient preferences or is only partially beneficial at a disproportionately high cost. It’s estimated that more than $40 billion is spent annually on medical tests and procedures that are unnecessary or not required to diagnose or treat patients.
A University of Sydney co-author of the review, Professor Adam Elshaug from the Menzies Centre for Health Policy said cognitive biases were evident across the medical field.
“We collected this evidence from across a range of medical services and it appears that cognitive biases are prevalent in all areas of medical care,” he said.
“It’s absolutely vital for patients ask questions of their clinicians to ensure they get treatments most suited to their health situation.”
“The Choosing Wisely Australia campaign recommends five questions patients should ask their doctors:
- Do I really need this test or procedure?
- What are the risks?
- Are there simpler, safer options?
- What happens if I don’t do anything?
- What are the costs?
“These questions may help to ensure patients have all the information they need to make a decision about their treatment,” he said.
Cognitive biases cover a range of situations including:
- Commission bias: doctors try to avoid experiencing a sense of regret at not administering an intervention that could have benefited at least a few recipients, leading them to over-administer treatments.
- Attribution bias: relying on anecdotal and selective observations of positive outcomes to a treatment may lead to undue confidence to its effectiveness.
- Impact bias: patients and clinicians tend to overestimate the benefits and underestimate the harms of treatments.
- Availability bias: emotionally strong case studies with either good or bad outcomes that come easily to mind can unduly inflate estimates of the likelihood of the same scenario being repeated.
- Ambiguity bias: even when the evidence that defines a treatment as being of low value is well known and accepted, treatments are still performed to reassure the patient or their peers.
Professor Elshaug said many cognitive biases overlap and often no single bias affects a clinician’s decision-making.
The review was led by Associate Professor Ian Scott at Princess Alexandra Hospital, and co-authored by clinicians and academics from the University of Queensland, the Royal Australasian College of Physicians, the University of Sydney and NPS MedicineWise.