Overconfidence in Clinical Decision Making

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Dual processing approach to decision making

Effective problem solving, sound judgment, and well-calibrated clinical decision making are considered to be among the highest attributes of physicians. Surprisingly, however, this important area has been actively researched for only about 35 years. The main epistemological issues in clinical decision making have been reviewed.7 Much current work in cognitive science suggests that the brain utilizes 2 subsystems for thinking, knowing, and information processing: System 1 and System 2.8, 9, 10,

Overconfidence

Overconfident judgment by clinicians is 1 example of many cognitive biases that may influence reasoning and medical decision making. This bias has been well demonstrated in the psychology literature, where it appears as a common, but not universal, finding.29, 30 Ethnic cross-cultural variations in overconfidence have been described.31 Further, we appear to be consistently overconfident when we express extreme confidence.29 Overconfidence also plays a role in self-assessment, where it is

Solutions and conclusions

Overconfidence often occurs when determining a course of action and, accordingly, should be examined in the context of judgment and decision making. It appears to be influenced by a number of factors related to the individual as well as the task, some of which interact with one another. Overconfidence is associated in particular with confirmation bias and may underlie hindsight bias. It seems to be especially dependent on the manner in which the individual gathers evidence to support a belief.

Author disclosures

The authors report the following conflicts of interest with the sponsor of this supplement article or products discussed in this article:

Pat Croskerry, MD, PhD, has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this article.

Geoff Norman, PhD, has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this article.

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

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