Easy Isn't Always Best

Imagine you are a physician at a successful medical practice. You have appointments booked back to back every day, and in order to keep on schedule you can spend no more than 15 minutes examining any one patient. You’re running late on this particular day and are in a hurry to get through your next appointment. You listen to a robust, young man describe his headaches. You quickly but politely inform him that his symptoms are common and he has nothing to worry about. You hurry to your next appointment, and do not learn until weeks later that the patient was hospitalized for a malignant brain tumor you had missed.

Why might the doctor have missed this diagnosis, despite his or her years of medical training and experience? When under stress, cognitive loading, or time constrictions, many of us utilize mental shortcuts called cognitive heuristics that can quickly and easily lead us to conclusions (Gilovich et al., 2002; Kahneman et al., 1982; Nisbett & Ross, 1980). Unfortunately, the conclusions formed based on cognitive heuristics can potentially be wildly inaccurate.

Like the fictional young man mentioned above, I too have experienced firsthand the effects of doctors using cognitive heuristics. At 15, I began to experience excruciating pain that would migrate throughout my body constantly. Every single doctor I saw to try to find an explanation would look at my chart, see my age, gender, and history of major depressive disorder and immediately inform me that untreated depression can sometimes cause physical pain. I went back on my antidepressants to rule that possibility out, but each new doctor would see the prescription on my chart as a confirmation of their original hunch that the root of the problem was ‘psychological, not biological.’ Five years later, I was finally diagnosed with a central nervous system infection. If the doctors had diagnosed me when I first sought medical help, I would have been cured within a few months with minimal permanent damage. Now, however, there’s absolutely no question that I will have permanent brain, nerve, and organ damage (likely to each of my organ systems), and cognitive function tests show that I’m mildly to severely impaired in all areas except reasoning. Treatment itself is also now a danger because of my sever immunosuppression, and I have already had life threatening complications.

Aside from the life threatening health issues, what do my story and the young man’s above have in common? In both of our stories, the doctors judged the probability that we would be seriously ill based on our affiliation with certain categories. The man was young and robust, both attributes you would normally not associate with a cancer patient. I, on the other hand, was a young, female patient with a history of mental illness, AKA the stereotypical patient to develop a psychosomatic disorder. The bottom line: doctors need to be especially wary of mental shortcuts, because an inaccurate cognitive heuristic can mean the difference between a simple mistake and a malpractice lawsuit.

(n = 500)

Gilovich, T., Griffin, D., & Kahneman, D. (Eds.). (2002). Heuristics and biases: The

psychology of intuitive judgment. New York: Cambridge University Press.

Kahneman, D., Slovic, P., & Tversky, A. (Eds.). (1982). Judgment under uncertainty:

Heuristics and biases. New York: Cambridge University Press.

Nisbett, R. E., & Ross, L. (1980). Human inference: Strategies and shortcomings of

social judgment. Englewood Cliffs, NJ: Prentice-Hall.