Wide range of professions use heuristics to assist them with complex decision making, doctors are no exception

Jul 27 2004

Correct treatment of serious medical conditions can be a matter of life and death for patients, so the quality of the processes by which doctors reach their decisions is critical.

A PhD research project at Australia's Flinders University hopes to gain better understanding of the approaches doctors use to resolve the uncertainties and complexities intrinsic to their professional practice.

Ms Ruth Sladek, a researcher in the Department of Medicine at Flinders, is particularly interested in the role played by heuristics, more commonly known as rules of thumb.

Ms Sladek says people in a wide range of professions use heuristics to assist them with complex decision making.

Doctors are no exception. In sifting through the huge numbers of variables and options involved in making a diagnosis and identifying an appropriate course of treatment, they too resort to personal sets of guiding principles.

Using heuristics as a tool is a natural response to complexity, Ms Sladek said.

"It makes sense because you can't sit down and systematically sift through every single piece of information for every decision you make - you would never progress or get anywhere," she said.

"Medical decision-making in particular is surrounded by uncertainty and complexity, so I'm interested to see how doctors might use rules of thumb, and in particular the implications on the occasions when they don't work."

Ms Sladek said that there are two opposing views of heuristics.

"One theory says heuristics are inherently flawed - while they may be good most of the time, there will always be a danger attached to their use. Another theory says they are ecologically adaptive, and sees them as a valuable way of making the most of the available information."

Ms Sladek's study of the role and the effectiveness of medical heuristics will focus on their use in doctors' choice of interventions. She is the recipient of an inaugural National Institute of Clinical Studies scholarship for the project.

Ms Sladek said the study has particular relevance in view of the growing international adoption of evidence-based practice, which involves scientific and statistical assessment of the efficacy of particular clinical treatments.

"There has been enormous public investment in evidence-based practice over the last 10 to 15 years, and there is a lot of interest in encouraging doctors to change their practice appropriately," she said.

She said research has shown that some doctors do not take up the recommendations of evidence-based practice, and there is a possibility that they may be preferring their own experience and rules of thumb.

At the same time, Ms Sladek does not suggest that heuristics are necessarily a bad thing.

"Perhaps there is a legitimate resistance in there, and perhaps doctors should retain the right to use their own judgments and decision-making to override a guideline they have been sent," she said.

"It also may be that some heuristics may prove to be well worth passing on through teaching."