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紐時賞析/心理思考捷徑 導致醫師診斷錯誤

偏見會以許多形式出現,影響醫師的思考,以及對治療所做的決定。示意圖/ingimage
偏見會以許多形式出現,影響醫師的思考,以及對治療所做的決定。示意圖/ingimage

How Common Mental Shortcuts Can Cause Major Physician Errors

心理思考捷徑 導致診斷錯誤

It’s tempting to believe that physicians are logical, meticulous thinkers who perfectly weigh the pros and cons of treatment options, acting as unbiased surrogates for their patients.

我們想要相信,醫師是有邏輯、小心謹慎的思考者,完美衡量治療選項的好與壞,以無偏見的病患代理人之姿行動。

In reality, this is often far from the case. Bias, which takes many forms, affects how doctors think and the treatment decisions they make.

現實卻往往遠非如此。偏見會以許多形式出現,影響醫師的思考,以及對治療所做的決定。

Racial biases in treatment decisions by physicians are well documented. One study found that black patients were significantly less likely than white patients to receive pain medication in the emergency department, despite reporting similar levels of pain. Other research suggests that long-standing racial biases among providers might have contributed to racial differences in patient trust in the health system.

醫師做治療決定時的種族偏見已有多案可考。一項研究發現,比起白人病患,黑人病患在急診部門比較不容易被施予止痛藥,即使自述的疼痛程度相當。另有研究指出,醫療提供者間長期存在種族偏見,可能是病患對醫療系統的信賴出現種族差異的原因。

But a growing body of scientific research on physician decision-making shows that doctors exhibit other biases as well — cognitive ones — that influence the way they think and treat patients. These biases lead doctors to make the same mistakes as the rest of us, but usually at a greater cost.

但是,針對內科醫師醫療決定而增加中的科學研究顯示,醫師也表現出認知類型的其他偏見,影響他們思考及治療患者的方式。這些偏見使醫師犯下和我們其他人一樣的錯誤,代價通常卻更大。

Cognitive biases refer to a range of systematic errors in human decision-making stemming from the tendency to use mental shortcuts.

認知偏見指人類做決定時的一些系統性錯誤,源自於使用心理捷徑的偏好。

Prominent examples include confirmation bias, the tendency to interpret new information in a way favorable to one’s preconceptions; and anchoring, the tendency to overly weight an initial piece of information, even when order does not matter. Anchoring helps explain why if you see a car priced at $20,000 and a second car priced at $8,000, you might conclude the second car is cheap, whereas if the first car cost $3,000 you might conclude that the second car is expensive.

顯著的例子包括「確認偏誤」,指一個人偏好以先入為主的想法,解釋新訊息的傾向,還有定錨,指過度重視初始資訊的傾向,即使訊息順序並不重要。定錨可解釋為何當你先看到定價2萬美元的車,再看到標價8000美元的車時,你可能會認為第二輛比較划算,然而若第一輛車要價3000美元,你可能認定第二輛賣得太貴。

In health care, such unconscious biases can lead to disparate treatment of patients and can affect whether similar patients live or die.

在醫療中,這些沒有意識到的偏見會使病患得到完全不同的治療,也會影響病情相似的患者是死是活。

Sometimes these cognitive biases are simple overreactions to recent events, what psychologists term availability bias. One study found 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.

有些時候,這些認知偏見就只是對新近事件的過度反應,心理學家稱之為「現成偏誤」。一項研究發現,若病患使用某種藥物發生意料之外的有害副作用,他們的醫師就較不可能開同一種藥給也許需要它的下一個病人,儘管這個藥物的效力和適用性並未改變。

A similar study found 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. This cognitive bias resulted in both higher spending and worse outcomes.

一項類似的研究發現,當分娩的產婦經歷一個不好的突發事件,她們的產科醫師比較有可能為下一位病人改變分娩方式(剖腹生產或陰道分娩),而非考慮下一位病人的適用情況。這個認知偏見同時導致更高的支出與更糟糕的後果。

文/Anupam B. Jena and Andrew R. Olenski 譯/莊蕙嘉 核稿/樂慧生

醫師 患者

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