Decision-making biases and doctor error: Cognitive dissonance by Prof Jill Klein

Posted on July 25, 2019

Professor Jill Klein is an esteemed academic and award-winning author with more than 30 years of teaching experience. Her specialities are resilience, decision-making, and managerial judgement. She has taught senior executives and MBA students in top-tier business schools around the world, including Kellogg Graduate School of Management at Northwestern University, INSEAD, and Duke University. She teaches leadership for the Melbourne Medical School’s Master in Clinical Education programme at the University of Melbourne and is leading the design for a new specialist Certificate in Clinical Leadership programme. In addition, Jill has led workshops in the public health sector and pharmaceutical companies.  

Author Quotes:  

You might make a diagnosis and then learn something that suggests it was wrong; you might use a treatment that you think should really help somebody and then see that the patient is on the decline; all of those things might cause cognitive dissonance.

One way that we take psychological hits is cognitive dissonance.

Research on clinicians who make errors has referred to clinicians in this situation as the ‘second victim’ because the research shows tremendous psychological harm that can result from making an error.

Summary and slides:  

Prof Klein starts this section of her presentation with a discussion of cognitive dissonance and how it plays a part in biases. 

She provides examples of experiments where participants are shown to choose the ethical option when made to feel incompetent. Concluding this section, she discusses how to recognise cognitive dissonance and how experiencing it can be helpful to make the right decision. 

She continues with a look at the vast number of decisions we all make every month and the likelihood of how many of them will be 100% correct. 

She ends this video excerpt by highlighting a study to investigate the effects of mindset on the perceptions of error. She reveals why someone of a fixed mindset who makes a mistake is more threatened by the mistake than someone of a growth mindset. 

Take-Home Points: 

  • Medical error is likely to cause cognitive dissonance and threat to identity, in addition to patient harm. 
  • Mindsets are important when examining the effects of making errors. 
  • The experience of dissonance is often less aversive than the consequences of self-justification. 
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