The American Journal of Medicine
Volume 121, Issue 5, Supplement , Pages S24-S29 , May 2008

Overconfidence in Clinical Decision Making

  • Pat Croskerry, MD, PhD

      Affiliations

    • Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
    • Corresponding Author InformationRequests for reprints should be addressed to Pat Croskerry, MD, PhD, Department of Emergency Medicine, Dalhousie University. 351 Bethune, VG Site, 1278 Tower Road, Halifax, Nova Scotia, Canada B3H 2Y9.
    • ,
  • Geoff Norman, PhD

      Affiliations

    • Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

References 

  1. Jenicek M, Hitchcock DL. Evidence-based practice: logic and critical thinking in medicine. US: American Medical Association Press; 2005;118–137
  2. Croskerry P. Timely recognition and diagnosis of illness. In:  MacKinnon N,  Nguyen T editor. Safe and Effective: the Eight Essential Elements of an Optimal Medication-use System. Ottawa, Ontario: Canadian Pharmacists Association; 2007;
  3. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study 1. N Eng J Med. 1991;324:370–376
  4. Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust. 1995;163:458–471
  5. Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000;38:261–271
  6. Berner E, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121(suppl 5A):S2–S23
  7. Norman GR. The epistemology of clinical reasoning: perspectives from philosophy, psychology, and neuroscience. Acad Med. 2000;75(suppl):S127–S133
  8. Bruner JS. Actual Minds, Possible Worlds. Cambridge, MA: Harvard University Press; 1986;
  9. Hammond KR. Intuitive and analytic cognition: information models. In:  Sage A editors. Concise Encyclopedia of Information Processing in Systems and Organizations. Oxford: Pergamon Press; 1990;p. 306–312
  10. Sloman SA. The empirical case for two systems of reasoning. Psychol Bull. 1996;119:3–22
  11. Evans J, Over D. Rationality and Reasoning. Hove, East Sussex, UK: Psychology Press; 1996;
  12. Stanovich KE, West RF. Individual differences in reasoning: implications for the rationality debate?. Behav Brain Sci. 2000;23:645–665discussion 665–726
  13. Stanovich KE. The Robot's Rebellion: Finding Meaning in the Age of Darwin. Chicago: University of Chicago Press; 2005;
  14. Zajonc RB. Feeling and thinking: preferences need no inferences. Am Psychol. 1980;35:151–175
  15. Fodor J. The Modularity of Mind. Cambridge, MA: MIT Press; 1983;
  16. Norman G. Building on experience—the development of clinical reasoning. New Engl J Med. 2006;355:2251–2252
  17. Norman GR, Brooks LR. The non-analytic basis of clinical reasoning. Adv Health Sci Educ Theory Pract. 1997;2:173–184
  18. Hatala R, Norman GR, Brooks LR. Influence of a single example upon subsequent electrocardiogram interpretation. Teach Learn Med. 1999;11:110–117
  19. Medin DL. Concepts and conceptual structure. Am Psychol. 1989;44:1469–1481
  20. Brooks LR. Decentralized control of categorization: the role of prior processing episodes. In:  Neisser U editors. Concepts and Conceptual Development. Cambridge, UK: Cambridge University Press; 1987;p. 141–174
  21. Gigerenzer G, Todd P. ABC Research Group (Simple Heuristics That Make Us Smart). New York: Oxford University Press; 1999;
  22. Eva KW, Norman GR. Heuristics and biases: a biased perspective on clinical reasoning. Med Educ. 2005;39:870–872
  23. Kulatunga-Moruzi C, Brooks LR, Norman GR. Coordination of analytic and similarity-based processing strategies and expertise in dermatological diagnosis. Teach Learn Med. 2001;13:110–116
  24. Ark TK, Brooks LR, Eva KW. Giving learners the best of both worlds: do clinical teachers need to guard against teaching pattern recognition to novices?. Acad Med. 2006;81:405–409
  25. Gladwell M. The Power of Thinking Without Thinking. New York: Little Brown and Co; 2005;
  26. Dijksterhuis A, Bos MW, Nordgren LF, van Baaren RB. On making the right choice: the deliberation-without-attention effect. Science. 2006;311:1005–1007
  27. Zhaoping L, Guyader N. Interference with bottom-up feature detection by higher-level object recognition. Curr Biol. 2007;17:26–31
  28. Risen J, Gilovich T. Informal logical fallacies. In:  Sternberg RJ,  Roediger HL,  Halpern DF editor. Critical Thinking in Psychology. New York: Cambridge University Press; 2007;
  29. Baron J. Thinking and Deciding. In: 3rd ed.. New York: Cambridge University Press; 2000;
  30. Griffin D, Tversky A. The weighing of evidence and the determinants of confidence. In:  Gilovich T,  Griffin D,  Kahneman D editor. Heuristics and Biases: The Psychology of Intuitive Judgment. New York: Cambridge University Press; 2002;p. 230–249
  31. Yates JF, Lee JW, Sieck WR, Choi I, Price PC. Probability judgment across cultures. In:  Gilovich T,  Griffin D,  Kahneman D editor. Heuristics and Biases: The Psychology of Intuitive Judgment. New York: Cambridge University Press; 2002;p. 271–291
  32. Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005;80(suppl):S46–S54
  33. Krueger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999;77:1121–1134
  34. Haselton MG, Buss DM. Error management theory: a new perspective on biases in cross-sex mind reading. J Pers Soc Psychol. 2000;78:81–91
  35. Tiedens L, Linton S. Judgment under emotional certainty and uncertainty: the effects of specific emotions on information processing. J Pers Soc Psychol. 2001;81:973–988
  36. Nickerson RS. Confirmation bias: a ubiquitous phenomenon in many guises. Rev Gen Psychol. 1998;2:175–220
  37. Rozenblit LR, Keil FC. The misunderstood limits of folk science: an illusion of explanatory depth. Cognit Sci. 2002;26:521–562
  38. Koriat A, Lichtenstein S, Fischoff B. Reasons for confidence. J Exp Psychol. 1980;6:107–118[Hum Learn]
  39. Arkes H, Faust D, Guilmette T, Hart K. Eliminating the hindsight bias. J Appl Psychol. 1988;73:305–307
  40. Katz J. Why doctors don't disclose uncertainty. In:  Elstein A,  Dowie J editor. Professional Judgment: A Reader in Clinical Decision Making. Cambridge, UK: Cambridge University Press; 1988;p. 544–565
  41. Croskerry PG. The feedback sanction. Acad Emerg Med. 2000;7:1232–1238
  42. Blackmore S. The Meme Machine. Oxford: Oxford University Press; 1999;
  43. Detmer DE, Fryback DG, Gassner K. Heuristics and biases in medical decision making. J Med Educ. 1978;53:682–683
  44. Lundeberg MA, Fox PW, Punccohar J. Highly confident but wrong: gender differences and similarities in confidence judgments. J Educ Psychol. 1994;114–12186
  45. Deaux K, Farris E. Attributing causes for one's own performance: the effects of sex, norms, and outcome. J Res Pers. 1977;11:59–72
  46. Landazabal MG. Psychopathological symptoms, social skills, and personality traits: a study with adolescents Spanish. J Psychol. 2006;9:182–192
  47. Fischhoff B, Slovic P. A little learning…: Confidence in multicue judgment. In:  Nickerson R editors. Attention and Performance.VIII. Hillsdale, NJ: Erlbaum; 1980;
  48. Lichenstein S, Fischoff B. Training for calibration. Organ Behav Hum Perform. 1980;26:149–171
  49. Arkes HR, Christensen C, Lai C, Blumer C. Two methods of reducing overconfidence. Organ Behav Human Decis Process. 1987;39:133–144
  50. van Gelder T, Bissett M, Cumming G. Cultivating expertise in informal reasoning. Can J Exp Psychol. 2004;58:142–152
  51. Croskerry P. The theory and practice of clinical decision making. Can J Anaesth. 2005;52:R1–R8
  52. Dane E, Pratt MG. Exploring intuition and its role in managerial decision making. Acad Manage Rev. 2007;32:33–54
  53. Epstein RM. Mindful practice. JAMA. 1999;9:833–839
  54. Henrion M, Fischoff B. Assessing uncertainty in physical constants. Am J Phys. 1986;54:791–798
  55. Croskerry P. The importance of cognitive errors in diagnosis and strategies to prevent them. Acad Med. 2003;78:1–6
  56. Krantz DH, Fong GT, Nisbett RE. Formal training improves the application of statistical heuristics in everyday problems. Murray Hill, NJ: Bell Laboratories; 1983;
  57. Lehman DR, Lempert RO, Nisbett RE. The effects of graduate training on reasoning: formal discipline and thinking about everyday life events. Am Psychol. 1988;43:431–432
  58. Nesbett RE, Fong GT, Lehman DR, Cheng PW. Teaching reasoning. Science. 1987;238:625–631
  59. Chi MT, Glaser R, Farr MJ. The Nature of Expertise. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988;
  60. Graber MA. Metacognitive training to reduce diagnostic errors: ready for prime time. [abstract] Acad Med. 2003;78:781
  61. Lehman D, Nisbett R. A longitudinal study on the effects of undergraduate education on reasoning. Dev Psychol. 1990;26:952–960
  62. Croskerry P. The affective imperative: Coming to terms with our emotions. Acad Emerg Med. 2007;14:184–186

 Statement of Author Disclosures: Please see the Author Disclosures section at the end of this article.

PII: S0002-9343(08)00152-6

doi: 10.1016/j.amjmed.2008.02.001

The American Journal of Medicine
Volume 121, Issue 5, Supplement , Pages S24-S29 , May 2008

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