Surgeon biases and mental shortcuts risk patient safety

Editor's Note

A surgeon’s cognitive biases, such as those influencing memory and information processing, were directly associated with surgical complications and patient harm, including death. These findings from a systematic review published in the December issue of Annals of Surgery.

Among 21 reviewed studies, 38 cognitive biases and heuristics (mental shortcuts) were present among surgeons in the OR. The review authors found that surgical errors, never events, and negative patient outcomes occurred across surgical specialties when biases such as overconfidence were present.

Cognitive biases of information processing, another type of bias noted, occurred when surgeons needed to make rapid decisions or judgments. These biases are often the result of the brain’s tendency to rely on efficient and automatic processes. Confirmation bias was also common. For example, in a controlled experimental study included in the review, confirmation bias was observed in 26.3% of initial diagnoses and 19.5% of final diagnoses when orthopedic surgeons were asked to solve clinical cases with an incorrect referral diagnosis, per the article.

The authors also acknowledged evidence-based benefits of implementing debiasing strategies to reverse negative outcomes caused by surgeon biases and heuristics. Such debiasing strategies included metacognition, prompting, and reflection, as well building and maintaining effective teams. While AI tools were not included in studies reviewed, the authors noted the role of AI in mitigating cognitive biases. However, they noted that as AI aims to mimic human learning, problem-solving, and decision-making, caution is needed to ensure that human cognitive biases are not integrated into AI models themselves.