Medical psychology and psychosomatics - exercise

Predictive brain: How mind creates emotions, reality and wrong clinical decisions

TAKE HOME MESSAGE


  • The brain was evolutionarily designed for survival, not for precise perception. 
  • To achieve this purpose, it relies on memory to anticipate (predict)   the upcoming moment at the sensory, visceromotor, and motor levels. 
  • Incorrect predictions pose cognitive traps for doctors, thus presenting a danger of errors in diagnosis and treatment.

COGNITIVE TRAPS IN MEDICINE (Important for the test)


1. Framing bias
  • "How it is presented”
  • The diagnosis is influenced by the way the patient is presented by the doctor or the patient themselves.
2. Availability bias
  • "You have seen in previous episodes"
  • Dg. that comes easily to the doctor. It's a dg. that the doctor has most likely recently read about or has treated a patient with similar symptoms.
3. Anchoring bias
  • "I'm holding on and not letting go.”
  • The doctor subconsciously overvalues clinical information that supports the chosen diagnosis (confirmation) and ignores or downplays other conflicting data.
4. Premature closure
  • "And we're done."
  • A positive result of a certain examination leads to the premature establishment of a diagnosis without sufficient verification.
5. Over-confidence
  • "It’s as clear as day."
  • The doctor has a sense of knowing more than he/she actually does and places too much confidence in his/her own opinion.

HOW TO OUTSMART COGNITIVE TRAPS?


  • Awareness of their existence (see their overview in the interactive outline) and keeping them in mind
  • Avoid relying solely on intuition and experience
  • Do not bet everything on a single diagnosis. Actively consider at least 2-3 alternative diagnoses. Consider which diseases, among those being considered, could threaten the patient's life within a few hours.
  • Verify information. Do not blindly trust the claims of others. 
  • Do not blindly trust your own judgment. Benefit from consultations and comprehensive visits.
  • Do not give the predictive brain complete control over your reactions (Refining our attention though good-quality sleep and mindfulness)

    REFERENCE A MATERIALS FOR FURTHER STUDY


    Reference: 

    • Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med. 2002 Nov;9(11):1184-204. doi: 10.1111/j.1553-2712.2002.tb01574.x. PMID: 12414468.

    Voluntary for inspiration (not necessary for the test):

    • Barrett LF. How Emotions Are Made: The Secret Life of the Brain. 2017
    • Barrett LF. Seven and a Half Lessons About the Brain. 2020
    • Barrett LF. The theory of constructed emotion: an active inference account of interoception and categorization. Soc Cogn Affect Neurosci. 2017;12(11):1833. doi:10.1093/scan/nsx060

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