Judgmental Error in Intensive Care Practice

Abstract

Clinical judgment and its sources of error are inves tigated by studying the clinician's use of mental strate gies, heuristics, and biases. I review these findings, which have been obtained by analyzing medical judg ment in nonintensive care settings, with emphasis on appropriate applications for the intensivist. Particularly important in the intensive care unit (ICU) setting are sources of judgmental error introduced by using hy pothesis-driven reasoning and by attempting to intu itively mimic probabilistic reasoning. Such mental short- cuts are intended to aid the clinician, but are potential hindrances if misused. During ICU decision making, cer tain tendencies toward error are accentuated and must be recognized and guarded against. Conversely the in tensivist's valid judgments can best be defended if the context and constraints of ICU decision making are well understood. I analyze those tendencies and contexts shown to be important to intensive care and review opportunities to improve both the practice and under standing of clinical judgment in this setting.