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Countering cognitive biases in minimising low value care

Professionally led initiatives, such as the Choosing Wisely Australia campaign (www.choosingwisely.org.au) and EVOLVE (Evaluating Evidence, Enhancing Efficiencies; http://evolve.edu.au), aim to raise awareness of, and reduce, low value care. This is care that confers little or no benefit, may instead cause patient harm, is not aligned with patient preferences, or yields marginal benefits at a disproportionately high cost. In this article, we discuss cognitive biases that predispose clinician decision making to low value care. We used PubMed listings of original articles from 1990 to 2015 related to cognitive bias in clinical decision making, including a recent systematic review,1 files of relevant publications held by the authors and sentinel texts in cognitive psychology as applied to clinical practice (Appendix). We believe that these biases need to be understood and addressed if campaigns such as Choosing Wisely and EVOLVE are to achieve their full potential.

Influence of cognitive biases on clinical decision making

Much of everyday clinical decision making is largely intuitive behaviour guided by mindlines (internalised tacit guidelines on how to manage common problems)