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  • Bradley Block

Communicating the Complexity of Decision Making to Patients

Updated: Aug 25, 2023


In medicine, the process of decision making is often complex and multi-faceted. Healthcare professionals frequently find themselves facing challenging choices while simultaneously trying to effectively communicate these decisions to their patients. This can pose a significant cognitive load as they navigate the intricacies of medical decision making. However, the complexity of these decisions should not overshadow the importance of ensuring that the information is conveyed in a manner that is understandable and relevant to the patient.


Decision Making in Medicine: Balancing Complexity and Communication


While physicians are engaged in conversations with patients, they are simultaneously engaged in active decision making. This cognitive juggling act can make it difficult to effectively communicate the reasoning behind these decisions. In fact, the more complex the decision, the greater the tendency to speak for oneself rather than for the patients. Physicians often find themselves justifying their decisions to both the patients and to themselves in real time.


Realizing that this multifaceted process is at play highlights the need to zoom out and reflect on our own communication styles. It is crucial to ensure that we are speaking not just to our audience, but for our audience as well.


Striking the Balance: Adapting Communication to Fit the Context


Within the medical field, healthcare professionals frequently encounter similar conditions and develop effective ways to explain complex ideas to patients. Over time, these explanations become refined through repetition, resulting in a decreased cognitive load for the healthcare provider.


While this advantage allows for a more streamlined decision-making process, it also frees up cognitive energy that can be redirected towards reading the room and assessing the level of patient understanding. It becomes essential to develop strategies during these interactions to maintain awareness and ensure effective communication with patients, caregivers, and colleagues.


This cognitive energy conservation, achieved through honed discussions or "spiels" (a Yiddish term with no direct English equivalent), is a natural response to our finite cognitive resources. As cognitive misers, we develop biases and heuristics to conserve energy. In medicine, these biases often serve as valuable tools for quickly solving problems. Through training and experience, healthcare professionals identify patterns that enable them to make rapid diagnoses and treatment decisions.


However, there are instances when patients present with symptoms but without significant examination findings, such as in cases of classic migraines. In such situations, physicians rely on the heuristics and patterns they have developed over time. Yet, it is important to remain vigilant and recognize when a conclusion is reached too hastily. Could there be additional data that challenges the initial diagnosis? It becomes crucial to consider ordering further lab tests, imaging studies, or consulting with specialists to ensure that reliance on heuristics is not excessive.


Furthermore, effectively communicating the uncertainty of certain diagnoses to patients leaves the door open for appropriate follow-up. Physicians must also be willing to acknowledge and recognize their own uncertainties. It is easy to fall victim to the IKEA effect, where one overvalues their own work. Similar tendencies can arise when physicians become overly attached to a specific diagnosis they have diligently assessed. Being open to the possibility of being incorrect and making necessary course corrections is vital. Equally important is the ability to explain the decision-making process to the patient, fostering trust and understanding.


Embracing Uncertainty: The Art of Course Correction


Navigating the landscape of medical decision making requires acknowledging the inherent uncertainties that can arise. It is not uncommon for patients to present with ambiguous symptoms or complex diagnostic puzzles. In these instances, healthcare professionals rely on the heuristics, patterns, and knowledge acquired through training, experience, and continued education.


However, recognizing when the reliance on heuristics may be leading to premature conclusions is key. It becomes crucial to seek additional data, such as laboratory tests or imaging studies, to ensure a comprehensive evaluation.


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