Weekly Article: Optimism and making bad decisions

by Sonny Tat
Children's National

This week's article comes from the New York Times and is called "Why we make bad decisions." It is written by an economist who shares her personal experience with a challenging diagnosis and what she learned in terms of how people--including medical professionals--make decisions.

The most interesting discussion is the role of optimism in negatively affecting our decision-making process. We tend to incorporate  information we want to hear and ignore the information that doesn't support what we think, even if it is just as valid. For example, when people were told that the chance of a bad event (for example, a surgical complication) was lower than they had initially thought, they adjusted their own estimates to reflect that optimism. But when they were told that the chance of a bad event was even higher than expected, they ignored that new information in their own risk assessments. In terms of applicability to pediatric emergency medicine, this is similar to existing literature outlining the role of confirmation bias and heuristics in misdiagnosis.

Not to sound dramatic, but I feel like in pediatric emergency medicine we make a lot of hard decisions with not a lot of obvious answers. In addition, many of our patients are relatively healthy so it's easy to be optimistic. "They'll be fine." However, we have to balance that with the skepticism that must come with working in the emergency room. Not everyone will be fine. So whether it's taking an extra minute to think about a decision critically or run an idea by a less biased colleague (maybe look for a pessimist), it's vital to actively fight our natural tendency to welcome optimism and shun the bad news when making decisions throughout the work day.