The problems with problem solving

Do you know how your doctor makes her decisions? Many have tried to understand the complexities of medical decision making, reasons why they sometimes are wrong and what we can do to improve the outcomes of decisions.

For example, when it comes to imaging, estimates of average diagnostic error rates ranging from 3% to 5%, there are approximately 40 million diagnostic errors involving imaging annually worldwide. The potential to improve diagnostic performance and reduce patient harm by identifying and learning from these errors is substantial.

A new study reveals that around 12 million people in the US are misdiagnosed in outpatient clinics each year – the equivalent to 1 in every 20 adults. According to the study researchers, the findings pose a “substantial patient safety risk.”

Morbidity and mortality conferences ascribe errors in technique, medical decision making or systemic errors, but we don't teach trainees how to correct the latter causes.

There are many kinds and styles of decision making:

1. Clinical decision making
2. Diagnosed v undiagnosed problem solving
3. Medical practice management and leadership decision making
4. Patient decision making
5. SHARED decision making
6. Ethical decision making
7. Complex problem solving
8. Problem solving styles
9. Technology driven problem solving
10. WICKED problem solving
11. Decision making under uncertainty
12. Using the intersection of AI and behavioral economics to change patient behavior, adherence and compliance.

The Flexner Report highlighted the importance of teaching medical students to reason about uncertainty. The science of medical decision making seeks to explain how medical judgments and decisions ought ideally to be made, how they are actually made in practice, and how they can be improved, given the constraints of medical practice. The field considers both clinical decisions by or for individual patients and societal decisions designed to benefit the public. Despite the relevance of decision making to medical practice, it currently receives little formal attention in the U.S. medical school curriculum. This article suggests three roles for medical decision making in medical education. First, basic decision science would be a valuable prerequisite to medical training. Second, several decision-related competencies would be important outcomes of medical education; these include

1)the physician's own decision skills,

2) the ability to use artificial intelligence and other technologies to improve their decision making skills,

3) the ability to guide patients in shared decisions,

4) the ability to make decisions under volatile, uncertain, complex and ambiguous conditions, and

5) knowledge of health policy decisions at the societal level.

6) the ability to solve right v right ethical problems

7) the ability to optimize the outcomes of problems where there are no solutions

Finally, decision making could serve as a unifying principle in the design of the medical curriculum, integrating other curricular content around the need to create physicians who are competent and caring decision makers.

At its core, medical professionals make decisions and predictions. But who gets to make the decisions and how do we close the decision deficit? We need to teach them the knowledge, skills, abilities, and competencies to do it better and hold them accountable for the outcomes.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs

Hand made in Denver