Doctors who don't pay attention: Success chasers

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  • Published: Dec 1, 2011
  • Author: David Bradley
  • Channels: MRI Spectroscopy
thumbnail image: Doctors who don't pay attention: Success chasers

Brain activity in doctors?

Functional magnetic resonance imaging (fMRI) has been used to look at the brain activity of 35 experienced physicians from various non-surgical disciplines as they make decisions. The study shows that those physicians seen to pay most attention to failures as well as successes become more adept at deciding on the correct treatment.

"'Success-chasing' not only can lead doctors to make flawed decisions in diagnosing and treating patients, but it can also distort the thinking of other high-stakes decision makers, such as military and political strategists, stock market investors, and venture capitalists," explains Read Montague director of the Human Neuroimaging Laboratory at the Virginia Tech Carilion Research Institute who headed up the study. The team's findings thus underscore the dangers of disregarding past failures when making high-stakes decisions."

Writing in the 23rd November issue of the online, peer-reviewed journal PLoS One Montague and colleagues explain how they have identified neural correlates of effective learning in experienced medical decision-makers. Montague worked with psychiatrist Jonathan Downar of the University of Toronto and Toronto Western Hospital, and Meghana Bhatt of the Beckman Research Institute, the City of Hope Hospital, Duarte, California.

The researchers used fMRI to investigate brain activity in 35 experienced physicians while they made decisions. The team asked the doctors to select between two treatments for a series of simulated emergency room diagnoses. The physicians were initially given the opportunity to learn by experience which of two medications worked best in a series of 64 simulated heart-attack patients in which six mock factors were given to the physicians. Unbeknownst to them only one of these six factors was actually relevant to the decision: whether or not the patients had diabetes or not. The simulation was set up so that one possible medication had a 75 percent success rate in patients with diabetes, but was only successful in 25 percent of patients without the disorder. The second medication had the opposite profile.

Snap decisions

The physicians were given a mere 10 seconds to make a rapid diagnosis and choose between the two treatment options. They were then flashed an outcome "SUCCESS" for heart attack successfully treated or "FAILURE" where the simulated patient did not respond.

"After the training, we tested the physicians to see how often they were able to pick the better drug in a second series of 64 simulated patients," explains Bhatt. "When we looked at their performance, the doctors separated into two distinct groups. One group learned very effectively from experience, and chose the better drug more than 75 percent of the time. The other group was terrible; they chose the better drug only at coin-flipping levels of accuracy, or half the time, and they also came up with inaccurate systems for deciding how to prescribe the medications, based on factors that didn't matter at all."

Montague explains that the fMRI showed a clear distinction between the apparent mental processes in the two groups. "The high performers activated their frontal lobes when things didn't go as expected and the treatments failed," he says. Such activity showed that the doctors learned from their failures and gradually improved their performance. Although all the subjects reported at least one of the five irrelevant factors, such as age or previous heart attack, as being relevant to their decision-making process.

The fMRI showed a marked contrast in the low performers whose frontal lobes lit up when outcomes occurred as expected. "In other words, they succumbed to 'confirmation bias,' ignoring failures and learning only from the successful cases," Bhatt says. "Each success confirmed what the low performers falsely thought they already knew about which treatment was better." The researchers termed this counterproductive learning pattern "success-chasing."

Chasing success

Of course, remembering the good times, the successes and forget or ignoring the bad, the failures, is not a constructive basis on which to make important decision as it does not allow the decision maker to abandon faulty ideas or misconceptions even in the light of new evidence that is contrary to their received wisdom or misplaces assumptions. "Instead, the ideas gain strength from each chance success, until they evolve into something like a superstition," explains Downar. "Notably, however, the most experienced doctors were the poorest learners," adds Montague.

Downar told SpectroscopyNOW that there is an upside to the study: "We may be able to train our young physicians to avoid success-chasing and confirmation bias by asking themselves [appropriate] questions," he says. "Most of the applications will be in teaching our physicians to think of alternative hypotheses and remember to orders the tests that would prove their diagnostic hunches wrong, not just the tests that would confirm their hunches," he told us. "Ultimately, these are just the basic principles of hypothesis-testing, and I think formal instruction in these principles in medical school would probably be helpful."

Downar points out that the same kinds of questions might also apply more broadly to non-physicians who are also trying to learn effectively from experience. He adds that, "Future studies are planned to look the effects of training physicians to get better at these kinds of tasks, either through a series of lessons or through neural feedback from real-time functional MRI performed while the physician does the task."

 

The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.

 Functional magnetic resonance imaging (fMRI) has been used to look at the brain activity of 35 experienced physicians from various non-surgical disciplines as they make decisions. The study shows that those physicians seen to pay most attention to failures as well as successes become more adept at deciding on the correct treatment.

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