Heuristics in the Emergency Room

Abstract

INTRODUCTION What do you think of when you hear the term emergency room? To most people, the term stirs up a specific image of a high volume of patients, critical traumas, potential life-and-death situations, high stress, and the need for quick decisions about clinical treatment. For the most part, this image is correct, and the clinicians working in an emergency department (ED) have to be able to work efficiently and effectively in this fast-paced, high-stress environment. As Dr. Jerome Groopman puts it in The Mistakes Doctors Make, “due to the high volume of patients in an emergency department, there is pressure put on the clinicians to see as many patients as quickly as possible and quick judgments are often rewarded.”1 In addition, emergency room clinicians are expected to treat large numbers of critically ill patients without knowing the patient’s medical history, and many of these patients will need significant medical decisions made concerning their illnesses. Therefore, ED clinicians are expected to not only see a great number of patients, many of whom are critically ill, but also do so in an expedited fashion with little background information on the patients. So, understanding what an ED clinician is up against, how does he or she need to think and reason about his or her patients? What factors affect the cognitive processes of clinicians working in an environment, such as an ED, that is fastpaced and stressful, yet requires quick, accurate decisions? In order to handle the mental stress of the emergency room, clinicians use cognitive “shortcuts” called heuristics to help them make medical decisions on a daily basis while minimizing mental effort. Heuristics can help clinicians think quickly, but may also cause problems if the clinician does not take care to be conscious about his or her thought processes. This paper presents the concept of heuristics in emergency medicine and addresses three common errors: the availability error, the representative error, and the fundamental attribution error.