Meng Li, Associate Professor and Director of Undergraduate Studies in the Department of Health and Behavioral Sciences, recently co-authored an article titled, “Physician’s flawed heuristics in the delivery room,” published in the journal Science. The article discusses the general background and implications of an original research article by Manasvini Singh in the same issue of Science.
Singh finds—through more than 86,000 patient medical records—that delivering physicians use a “win-stay/lose-shift” heuristic or decision rule in delivery mode decisions. That is, if the physician delivers a baby via vaginal birth, and the delivery has complications, this physician is more likely to switch to cesarean delivery for the very next patient; if the physician delivers a baby via cesarean and the delivery has complications, this physician is more likely to switch to vaginal delivery for the very next patient. This effect does not mean that physicians always switch to a different delivery mode between two patients. It means that physicians are more likely to switch to a different delivery mode for the next patient if the delivery for the immediately prior patient has complications, than if the prior patient’s delivery has no complications. The delivery mode switch leads to small, but concrete negative health consequences for mother and baby, including higher risk of death, lower chance of being discharged, and more outpatient visits the following month.
Li’s article discusses the potential psychological mechanisms behind this effect, as well as what to do with this finding. Li argues this finding is not an opportunity to blame doctors; but instead, it provides evidence that well-trained doctors are not immune to the well-established finding in decision science—humans are not perfect or always rational, and hey frequently rely on heuristics in decision making. The doctors’ misapplication of the otherwise useful heuristic of “win-stay/lose-shift” cannot be addressed until medicine as a whole can embrace the concept that humans are not perfectly rational. Only then can medicine be more open to studying and implementing decision aids that can help doctors make better decisions in high-pressure, complex situations such as the delivery room.