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To Do or Not to Do: A Critique of Medical Reason

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Clinical Inertia

Abstract

This central chapter of the book proposes an analysis of the psychology of medical decisions, often based on mental processes called heuristics, described in particular by Kahneman and Tversky and that have the advantage of rapidity: for example the representativeness heuristic has us ask how the patient in front of us resembles patients in a specific category, or the availability heuristic has us assess the probability of an event by the ease with which we can recall having already seen it. We also evoke the importance of loss aversion, described by Kahneman and Tversky in their Prospect Theory. Yet the use of these heuristics presents a risk of bias and error. We also analyze the effect of emotions, in particular the avoidance of regret in medical reasoning, while feelings are absent in Evidence-Based Medicine. We conclude that the discordance between the Technical Rationality of Evidence-Based Medicine, relying on the unbiased methodology of randomized clinical trials and the “medical reason” of the physician, which relies on heuristics and emotions with their risk of bias, represents a general explanation of clinical inertia, which can be seen as a preference for the status quo.

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  1. Avicenne Hospital and Paris 13 University, Sorbonne Paris Cité, Bobigny, France

    Gérard Reach

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Reach, G. (2015). To Do or Not to Do: A Critique of Medical Reason . In: Clinical Inertia. Springer, Cham. https://doi.org/10.1007/978-3-319-09882-1_6

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  • DOI: https://doi.org/10.1007/978-3-319-09882-1_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09881-4

  • Online ISBN: 978-3-319-09882-1

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