title: Smart strategies for doctors and doctors-in-training: heuristics in medicine.
abstract: BACKGROUND
  How do doctors make sound decisions when confronted with probabilistic data, time pressures and a heavy workload? One theory that has been embraced by many researchers is based on optimisation, which emphasises the need to integrate all information in order to arrive at sound decisions. This notion makes heuristics, which use less than complete information, appear as second-best strategies. In this article, we challenge this pessimistic view of heuristics.
  
  
  METHODS
  We introduce two medical problems that involve decision making to the reader: one concerns coronary care issues and the other macrolide prescriptions. In both settings, decision-making tools grounded in the principles of optimisation and heuristics, respectively, have been developed to assist doctors in making decisions. We explain the structure of each of these tools and compare their performance in terms of their facilitation of correct predictions.
  
  
  RESULTS
  For decisions concerning both the coronary care unit and the prescribing of macrolides, we demonstrate that sacrificing information does not necessarily imply a forfeiting of predictive accuracy, but can sometimes even lead to better decisions. Subsequently, we discuss common misconceptions about heuristics and explain when and why ignoring parts of the available information can lead to the making of more robust predictions.
  
  
  CONCLUSIONS
  Heuristics are neither good nor bad per se, but, if applied in situations to which they have been adapted, can be helpful companions for doctors and doctors-in-training. This, however, requires that heuristics in medicine be openly discussed, criticised, refined and then taught to doctors-in-training rather than being simply dismissed as harmful or irrelevant. A more uniform use of explicit and accepted heuristics has the potential to reduce variations in diagnoses and to improve medical care for patients.
authors: Center of Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Berlin, Germany. wegwarth@mpib-berlin.mpg.de
authors: Odette
authors: O
authors: Wegwarth
authors: Wolfgang
authors: W
authors: Gaissmaier
authors: Gerd
authors: G
authors: Gigerenzer
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003327:Coronary Disease / Q000175:diagnosis* / Q000188:drug therapy; D003657:Decision Making; D004501:Education, Medical / Q000379:methods*; D019317:Evidence-Based Medicine / Q000193:education*; D005260:Female; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D011340:Problem Solving
chemical_list: D018942:Macrolides