There are other studies that show that after “bad” events, physicians switch strategies. Take the win-stay/lose-shift strategy, for example.

However, identifying the optimal decision in real life is difficult because you usually don’t know what could have been: the counterfactual. Useful time-saver or dangerous bias?Ī bias arising from a heuristic implies a deviation from an “optimal” decision. Whether the use of such heuristics leads to poor outcomes – whether it can be called a “bias” – is still a matter of debate. There is growing evidence that experts in a variety of fields – such as forensic scientists, real estate agents, elite athletes, judges, academics and physicians – do, in fact, rely on heuristics. Researchers have been especially interested in how experts use heuristics, since it is not immediately clear whether people with enhanced knowledge of their specialized fields fall prey to the same decision-making flaws that afflict the lay individual. At that point, they switch strategies – like trying a different delivery mode. According to this heuristic, individuals stick with a strategy until they experience a “loss,” such as a labor-and-delivery complication. Take, for instance, the “win-stay/lose-shift” heuristic, which has been seen in birds, bees, rats, monkeys, children and adults. There are several heuristics that could explain the switching behavior I identified in the delivery room data.

While these mental shortcuts are often useful for making immediate judgments with limited information, they can lead people to make very predictable mistakes. Since psychologists Amos Tversky and Nobel laureate Daniel Kahneman introduced the idea of heuristics and biases into the mainstream a few decades ago, researchers have conducted hundreds of studies establishing the various types of heuristics people rely on in various contexts.

For instance, if the physician switches delivery modes after the prior delivery had complications, my analysis found that the second patient and/or her baby are more likely to die than if the physician had switched delivery modes after no prior complications. There is evidence that this switching heuristic is harmful to the affected patient. And patients at poorly resourced hospitals that have higher numbers of labor-and-delivery complications are more likely to be affected – as physicians experience more difficulties, this heuristic means they’ll be swayed toward more potentially inappropriate delivery choices. It’s a sizable effect, considering the baseline effect should be zero. That’s about 50 potentially inappropriate vaginal deliveries per year per hospital. Complications during a cesarean increased the likelihood of a subsequent vaginal delivery by up to 3.4%. That’s about 23 potentially inappropriate C-sections per year per hospital. It appears physicians may overcorrect after a bad outcome, tending to shy away from the decision they believe caused it – even when faced with a new patient with her own unique circumstances.Ĭomplications during a vaginal delivery increased the likelihood of a subsequent C-section by up to 3.6%. For example, if the physician’s last patient hemorrhaged during her vaginal delivery, the physician is more likely to perform a cesarean delivery for their next patient, even if a C-section is not indicated for that patient.Ī doctor may lean toward a C-section because the last vaginal delivery had complications. Looking at two academic hospitals’ data from more than 86,000 deliveries over 21 years, I saw that physicians who experienced complications during one patient’s delivery were more likely to switch to the other mode of delivery for their next patient, regardless of what the situation calls for. In my recent research published in the journal Science, I found that physicians use heuristics in the delivery room in ways that could potentially harm the mother and baby. There are all kinds of decisions a doctor must make while attending a birth: Should a woman continue to labor if the baby shows signs of distress? What interventions are warranted? Is it time for an emergency cesarean? The physician is responsible for life-and-death choices in a fraught, emotional environment. I’m a health economist interested in the intersection of applied decision theory and health care. While the average person’s reliance on heuristics is usually of little concern to society, the use of heuristics by physicians can have serious consequences.

Difficult decisions