The heuristics of childbirth

Published in Science, a study by Professor Manasvini Singh (University of Massachusetts) revealed that medical staff in delivery rooms were affected by the outcome of the previous childbirth when making decisions about their current patient.

3.6 percent of medical decision-makers were more likely to switch to caesarean, if their previous patient had complications with a vaginal delivery; 3.4 percent were more likely to switch to vaginal delivery if the previous patient experienced complications with a caesarean.

Singh noted this “suboptimal heuristic” often led to poorer patient outcomes. (Heuristics may be described as mental shortcuts that are used to ease the cognitive load of making a decision.)

Singh’s study drew on the electronic health records of more than 86,000 cases, and demonstrated the practice was also common among more experienced doctors, not just junior medics.

Singh invited commentary from psychologist and behavioural scientist Meng Li (University of Colorado) and marketing professor Helen Colby (Indiana University), who co-authored another article for Science, entitled Physicians' flawed heuristics in the delivery room; Complicated childbirths can influence later decision-making (15 October 21).

Li and Colby’s paper recommended that doctors stop relying on mental shortcuts when making decisions about patient care with limited cognitive resources. They drew attention to a "win-stay-lose-shift" heuristic that works well, but only in certain settings.

"In the medical context, this heuristic would be rational only if the specifics of the prior patient matched the specifics of the current patient and thus provided a useful learning experience. In that case, if one patient's delivery went wrong, it can tell the physician that the same delivery plan may not work well with another patient with very similar characteristics and indications. However, two patients who happen to have consecutive deliveries by the same physician are not expected to be highly similar."

Colby and Li stressed that the findings should not undermine doctors but rather highlight an important reality that, like all experts, doctors are human.

“It is time to acknowledge the prevalence of heuristics and decision biases in clinical practice and to view these patterns as predictably human instead of blaming individual doctors,” said Li and Colby. “Only then can we start helping doctors improve clinical decisions and, as a result, the health of the public.”

More at: Science