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Use of Heuristics during the clinical decision process in from family physicians in real conditions.

Rationale, aims and objectives: The available evidence on the existence
and consequences of the use of heuristics in the clinical decision
process is very scarce. The purpose of this study is to measure the use
of the Representativeness, Availability and Overconfidence heuristics in
real conditions with Primary Care physicians in cases of dyspnea and to
study the possible correlation with diagnostic error. Methods: A
prospective cohort study was carried out in 4 Primary Care centers in
which 371 new cases or dyspnea were registered. The use of the three
heuristics in the diagnostic process is measured through an operational
definition of the same. Subsequently, the statistical correlation with
the identified clinical errors is analyzed. Results: In 9.97% of the
registered cases a diagnostic error was identified. In 49.59% of the
cases, the physicians used the representativeness heuristic in the
diagnostic decision process. The availability heuristic was used by
82.38% of the doctors and finally, in more than 50% of the cases the
doctors showed excess confidence. None of the heuristics showed a
statistically significant correlation with diagnostic error. Conclusion:
The three heuristics have been used as mental shortcuts by Primary Care
physicians in the clinical decision process in cases of dyspnea, but
their influence on the diagnostic error is not significant. New studies
based on the proposed methodology will allow confirming both its
importance and its association with diagnostic error.