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General medicine
Clinicians’ cognitive biases: a potential barrier to implementation of evidence-based clinical practice
  1. Claudia Caroline Dobler1,
  2. Allison S Morrow1,
  3. Celia C Kamath2
  1. 1 Evidence-Based Practice Center, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Division of Health Care Policy and Research, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Claudia Caroline Dobler, Evidence-Based Practice Center, Mayo Clinic, Rochester MN 55905, USA; dobler.claudia{at}

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The uptake of new evidence in healthcare relies on clinicians’ willingness to change their clinical practice by implementing an evidence-based clinical intervention or deimplementing an obsolete, non-evidence-based practice. A number of barriers to change among health professionals have been identified including the way that clinicians make medical decisions. When clinicians judge situations, make decisions and solve problems, they routinely use cognitive shortcuts, also called ‘heuristics’, as well as internalised tacit knowledge (based on clinicians’ own experiences, exchange with colleagues, reading information and hearing from opinion leaders, patients, pharmaceutical representatives, and so on).1 Mental shortcuts can assist clinicians to process large amounts of information in a short time and are an important tool for experienced clinicians to make a correct diagnosis based on recognition of internalised patterns of signs of symptoms. They also have the potential, however, to prevent evidence-based decisions.

Here, we will outline a number of cognitive biases that constitute potential barriers to the practice of evidence-based medicine and potential solutions to address and overcome these biases. It is unknown to which extent cognitive biases play a role in clinicians’ decision-making, but some evidence suggests that cognitive biases in medical decision-making might be common.2 In a study on anaesthesiology practice, of nine types of cognitive errors selected for observation, seven occurred in >50% of observed emergencies.2

Examples of cognitive biases in clinical decision-making

The following cognitive biases typically influence clinicians’ decision-making regarding treatment and management of patients and are thus potential barriers to evidence-based clinical practice (figure 1).

Figure 1

Illustrations of clinicians’ cognitive biases. COPD, chronic obstructive pulmonary disease.

Omission bias

Omission bias is the tendency to judge actions that lead to harm as worse or less moral than equally harmful non-actions (omissions). The inclination is thus towards inaction following the principle of ‘do no harm’. Kahneman and Miller explained this bias in terms of norm theory: …

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  • Contributors CCD conceived the idea. CCD, CCK and ASM drafted and revised the manuscript.

  • Funding This study was funded by the National Health and Medical Research Council (Fellowship for CCD (APP1123733)).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.