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      Heuristic decision making in medicine

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          Abstract

          Can less information be more helpful when it comes to making medical decisions? Contrary to the common intuition that more information is always better, the use of heuristics can help both physicians and patients to make sound decisions. Heuristics are simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors. We discuss: (i) how doctors and patients use heuristics; and (ii) when heuristics outperform information-greedy methods, such as regressions in medical diagnosis. Furthermore, we outline those features of heuristics that make them useful in health care settings. These features include their surprising accuracy, transparency, and wide accessibility, as well as the low costs and little time required to employ them. We close by explaining one of the statistical reasons why heuristics are accurate, and by pointing to psychiatry as one area for future research on heuristics in health care.

          Translated abstract

          Es posible que menos información sea más útil cuando hay que tomar decisiones medicas? Contrariamente a la intuición habitual de que más información siempre es mejor, el empleo de los heurísticos puede ayudar a los medícos y a los pacientes a tomar decisiones acertadas, Los heurísticos consisten en estrategias simples de decisión que ignoran parte de la información disponible y que se basan solamente en unos pocos prediciores relevantes. En este artículo se discute: 1) ¿cómo emplean los heurísticos los medicos y los pacientes? y 2) ¿cuándo los heurísticos superan a los métodos ávidos de información, como las regresiones, en el diagnóstico médico? Además, se esbozan las características de los heurísticos que permiten que sean útiles en los ambientes clínicos. Estas características incluyen la sorprendente precisíon, transparencía y amplia accesibilidad, como también los bajos cosios y el poco tiempo requerido para emplearlos. Se concluye explicando una de las razones estadísticas por las cuales los heurísticos son precísos, y se señala que la psiquiatría es un área de investigación a futuro acerca de los heurísticos en clínica.

          Translated abstract

          Une information partielle peut-elle être plus utile quand il s'agit de prendre une décision médicale? Contrairement a l'idée courante qu'il est toujours mieux d'avoir plus d'information, l'utilisation des heuristiques peut aider le médecin et le patient a prendre les bonnes décisions. Les heuristiques sont des stratégies de décision simples qui font fi de l'information disponible, fondant seulement les décisions sur quelques prédicteurs pertinents. Nous examinons: 1) la façon dont les médecins et les patients utilisent les heuristiques; et 2) les moments où les heuristiques obtiennent de meilleurs résultats que les méthodes avides d'information, comme les modèles de régression dans le diagnostic médical. De plus, nous soulignons ces caractéristiques des heuristiques qui les rendent utiles dans le cadre des soins de santé: leur précision étonnante, leur transparence et leur grande accessibilité, ainsi que le faible coût et le peu de temps qu'il faut pour les employer. Nous terminons en expliquant une des raisons statistiques de la précision des heuristiques, et en mettant en avant la psychiatrie comme un domaine de recherche future sur les heuristiques pour les soins de santé.

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              Heuristic decision making.

              As reflected in the amount of controversy, few areas in psychology have undergone such dramatic conceptual changes in the past decade as the emerging science of heuristics. Heuristics are efficient cognitive processes, conscious or unconscious, that ignore part of the information. Because using heuristics saves effort, the classical view has been that heuristic decisions imply greater errors than do "rational" decisions as defined by logic or statistical models. However, for many decisions, the assumptions of rational models are not met, and it is an empirical rather than an a priori issue how well cognitive heuristics function in an uncertain world. To answer both the descriptive question ("Which heuristics do people use in which situations?") and the prescriptive question ("When should people rely on a given heuristic rather than a complex strategy to make better judgments?"), formal models are indispensable. We review research that tests formal models of heuristic inference, including in business organizations, health care, and legal institutions. This research indicates that (a) individuals and organizations often rely on simple heuristics in an adaptive way, and (b) ignoring part of the information can lead to more accurate judgments than weighting and adding all information, for instance for low predictability and small samples. The big future challenge is to develop a systematic theory of the building blocks of heuristics as well as the core capacities and environmental structures these exploit.
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                Author and article information

                Contributors
                University of Lausanne, Lausanne, Switzerland
                Max Planck Institute for Human Development, Berlin, Germany
                Journal
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues in Clinical Neuroscience
                Les Laboratoires Servier (France )
                1294-8322
                1958-5969
                March 2012
                March 2012
                : 14
                : 1
                : 77-89
                Affiliations
                University of Lausanne, Lausanne, Switzerland
                Max Planck Institute for Human Development, Berlin, Germany
                Author notes
                Article
                10.31887/DCNS.2012.14.1/jmarewski
                3341653
                22577307
                4a09b993-24fa-49dc-91d9-0fd4560f688c
                Copyright: © 2012 LLS

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Clinical Research

                Neurosciences
                biases,decision aids,fast-and-frugal heuristics,bounded rationality,ecological rationality,medical decision making

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