Department of Pediatric Critical Care, Rebecca Seiff Medical Center, Derech HaRambam, Safed 13100, Israel.
Emergency Medicine Program, Zefat Academic College, 11 Jerusalem St., Safed 1320611, Israel.
Int J Qual Health Care. 2022 Mar 9;34(1). doi: 10.1093/intqhc/mzac009.
This concept paper introduces the phenomenon of self-assigning a 'perceived reliability' value to medical device readings as a potential source of cognitive bias in medical decision-making. Medical errors can result from clinical decisions based on partial clinical data despite medical device readings providing data to the contrary. At times, this results from clinician distrust of medical device output. Consequentially, clinicians engage in a form of 'frozen thinking', a fixation on a particular thought process despite data to the contrary. Many medical devices, such as intensive care unit (ICU) monitors and alarms, lack validated statistics of device output reliability and validity. In its absence, clinicians assign a self-perceived reliability value to device output data and base clinical decisions therefrom. When the perceived reliability value is low, clinicians distrust the device and ignore device readings, especially when other clinical data are contrary. We explore the cognitive and theoretical underpinnings of this 'perceived reliability' phenomenon. The mental assignment of a perceived reliability value stems from principles of 'script theory' of medical decision-making. In this conceptual framework, clinicians make decisions by comparing current situations to mental 'scripts' of prior clinical decisions and their outcomes. As such, the clinician utilizes scripts of prior experiences to create the perceived reliability value. Self-assigned perceived reliability is subject to multiple dangers of reliability and cognitive biases. Some of these biases are presented. Among these is the danger of dismissing device readings as 'noise'. This is particularly true of ICU alarms that can emit frequent false alarms and contribute to clinician sensory overload. The cognitive dangers of this 'noise dismissal' are elaborated via its similarity to the phenomenon of 'spatial disorientation' among aviation pilots. We conclude with suggestions for reducing the potential bias of 'perceived reliability'. First presented are regulatory/legislative and industry-based interventions for increasing the study of, and end-user access to, validated device output reliability statistics. Subsequently, we propose strategies for overcoming and preventing this phenomenon. We close with suggestions for future research and development of this 'perceived reliability' phenomenon.
这篇概念论文介绍了一种现象，即医务人员会自行给医疗器械的读数赋予一个“感知可靠性”值，而这可能成为医疗决策过程中认知偏差的一个来源。尽管医疗器械的读数提供了与部分临床数据相反的数据，但临床决策仍可能基于这些部分临床数据而出现医疗失误。有时，这是由于临床医生不信任医疗器械的输出结果。因此，临床医生会陷入一种“僵化思维”，即尽管有相反的数据，但仍坚持特定的思维过程。许多医疗器械，如重症监护病房（ICU）监护仪和警报器，缺乏经过验证的设备输出可靠性和有效性统计数据。在缺乏这些数据的情况下，医务人员会自行给设备输出数据赋予一个感知可靠性值，并据此做出临床决策。当感知可靠性值较低时，医务人员会不信任设备并忽略设备读数，尤其是当其他临床数据与之相悖时。我们探讨了这种“感知可靠性”现象的认知和理论基础。这种感知可靠性值的心理赋值源于医疗决策的“脚本理论”原则。在这个概念框架中，医务人员通过将当前情况与先前临床决策及其结果的心理“脚本”进行比较来做出决策。因此，医务人员利用先前经验的脚本来创建感知可靠性值。自行赋予的感知可靠性值容易受到多种可靠性和认知偏差的影响。我们提出了其中一些偏差。其中一个危险是将设备读数视为“噪声”而不予理会。这在 ICU 警报器中尤其如此，因为它们可能会频繁发出虚假警报，导致临床医生的感官超负荷。通过将这种“噪声忽略”与航空飞行员的“空间定向障碍”现象进行类比，详细阐述了其认知危险。最后，我们提出了减少“感知可靠性”潜在偏差的建议。首先提出的是加强对医疗器械输出可靠性统计数据的研究和终端用户获取的监管/立法和行业干预措施。随后，我们提出了克服和预防这种现象的策略。最后，我们对这一“感知可靠性”现象的未来研究和发展提出了建议。
