To Do or Not to Do?-How People Make Decisions

Merry AF

Outcomes in healthcare depend a great deal on thequality of decisions made by the people who care for patients. Inthe early days of cardiac surgery decisions were often made onthe basis of authority by surgeons with broadly based knowledgeand skill, developed through extensive training and very longhours of work. The philosophy of the ?captain of the ship? prevailed.The advent of much greater specialization and the emergenceof evidence based medicine have led to a shift to a modelof decision making in which expertise trumps authority. There hasalso been a reduction in the length of hours worked by many doctors,and greater emphasis on involving patients in decisionsabout their own healthcare. The framework for understandinghuman error has been refined on the basis of empirical andtheoretical considerations, and much importance is now placedon the way in which the system as a whole is designed.Unfortunately the complexity of healthcare today is such thatsome of its properties are best explained through analogies tochaos theory. Furthermore, empirical work suggests that humanbeings are clearly strong at recognizing patterns, and are lessadroit at analyzing complex and unfamiliar situations from firstprinciples in a short time. It follows that the very extensive experienceof some of the older practitioners may have been morevaluable in decision making than many of the very reasonableand logical advances that have influenced modern practice.
References:Merry AF To Do or Not to Do?-How People Make Decisions JECT 2011;43:39-43
Institution(s):University of Auckland, Auckland New Zealand