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Cognitive Heuristics in Medicine

Heuristics are incredibly useful to help us make decisions quickly and effectively. But, by definition, heuristics do not take into account the nuances and complexities of the real world.

One of the most widely known heuristics, especially in retail, is the left-digit bias. This describes a situation in which consumers notice the first digit, i.e. the left-most digit in the Arabic numeral system, and put more weight on its value as opposed to the rest of the number. In practice, this means that consumers might see a product that is 6.99 as substantially cheaper than a product that is 7.00 despite there only being a 1 cent difference. In fact, research from the University of Chicago shows that consumers perceive this difference as being worth almost 25 cents. Quite a lot more than most expect!

Image courtesy of Chicago Booth, 2019

This is especially frightening, however, in medicine, where we expect our physicians and caretakers to treat us without regard to anything else (including cost in America, though a separate issue).

In this article in the New York Times, Jena and Olsenki describe a few cases in which cognitive heuristics can have adverse effects on patients. For example, they show: (1)”that when patients experienced an unlikely adverse side effect of a drug, their doctor was less likely to order that same drug for the next patient whose condition might call for it, even though the efficacy and appropriateness of the drug had not changed” and (2) “that when mothers giving birth experienced an adverse event, their obstetrician was more likely to switch delivery modes for the next patient (C-section vs. vaginal delivery), regardless of the appropriateness for that next patient.”

In their own study, Jena and Olsenki report the impact of left-digit bias:

This is the bias that explains why many goods are priced at $4.99 instead of $5, as consumers’ minds round down to the left-most digit of $4.

We hypothesized that doctors may be overly sensitive to the left-most digit of a patient’s age when recommending treatment, and indeed, in cardiac surgery they appear to be. When comparing patients who had a heart attack in the weeks leading up to their 80th birthdays with those who’d recently had an 80th birthday, we found that physicians were significantly less likely to perform a coronary artery bypass surgery for the “older” patients. The doctors might have perceived them to be “in their 80s” rather than “in their 70s.” This behavior seems to have translated into meaningful differences for patients. The slightly younger patients, more likely to undergo surgery, were less likely to die within 30 days.

Anupam Jena and Andrew Olsenki

These issues might not be that surprising in retrospect, given that physicians are humans too, just like anyone else.

Dossier

“How Common Mental Shortcuts Can Cause Major Physician Errors,” by Anupam Jena and Andrew Olsenki, February 20, 2020. https://www.nytimes.com/2020/02/20/upshot/mental-shortcuts-medical-errors.html

“Do Language Heuristics Reduce Creativity?” by Sahil Nawab, May 15, 2019. http://www.sahilnawab.com/blog/do-language-heuristics-reduce-creativity/

“Many retailers are making a basic mispricing mistake,” by Robin I. Mordfin, December 11, 2019. https://review.chicagobooth.edu/marketing/2019/article/many-retailers-are-making-basic-mispricing-mistake

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2 Comments

  1. Nasima

    This was very informative for me and I like your insights.

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