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Perception and Critical Thinking -- Issues with the use of Heuristics in Emergency Medicine

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Quick! The patient in front of you is desperately gasping for breath — what do you do? Oxygen? Medication? CPR? In the field of emergency medicine, these are the split-second calls that need to be made. Professionals often learn to use heuristics, which are short-cut rules of thumb, for understanding how to perceive something based on past experience; but is that the most reliable way to evaluate a situation? Three weaknesses of the heuristic approach is that it is susceptible to personal prejudice, selective perception, and forced consistency fallacies. When an emergency responder fails to see the specific details of a case because of assumptions about their patient’s demographic or cultural group, they have fallen victim to their own personal prejudices. For example, a team treating a disheveled or unclean homeless person may assume that any behavioral issues are the result of some alcohol or substance abuse. I’ve seen stereotypes about the pain tolerance of women, or use of “alternative treatments” among Latin populations, cause responders to act differently toward a person based on prejudice — a behavior called discrimination.

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While many persons within a cultural group may have certain traits in common, making overbroad assumptions about those patients can make an objective assessment difficult, or impossible. Another flaw of the heuristic approach is our tendency toward selective perception. Selective perception is the perceptual distortion that arises from paying attention only to what we expect to see or hear, and ignoring what we don’t expect. Often, our own desire for our patients to be healthy can hide their true symptoms from us. In the field of emergency medical training, we work hard to teach responders to avoid selective perception by looking at each case wholistically — collecting information about every aspect of a case before making any conclusions. A final weakness of heuristics in patient treatment is called forced consistency. Similar to selective perception, forced consistency happens when our desire to avoid contradictions causes us to misinterpret several perceptions so that they agree with each other. When treating a patient who has nearly all the key symptoms for a particular diagnosis, for example, it’s deceptively easy to bend our perspective of any contradicting symptoms so that everything “matches”. It’s reasonable to desire a logical, orderly environment; but when that becomes our priority, it can lead to unintentional misdiagnoses. Are we, as emergency medical responders, then fated to make flawed diagneses? Not necessarily.

Although there are several pitfalls with the use of heuristics in medicine, the risks can be cut significantly through the simple practice of critical thinking and conscious processing. When we deliberately examine and reflect about the information available to us, we can identify these common fallacies before they influence our perception. Critical thinking teaches us to be skeptical of our assumptions, and to challenge our own conclusions against the available evidence. In this way, the weaknesses of the heuristic approach, personal prejudice, selective perception, and forced consistency, will not prevent us from being able to provide the best, most accurate, treatment for our patients.

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