Whether a woman is giving birth or a man is having a 癌症 biopsy, 医疗护理很少是直截了当的. 在任何时候, 可能会出现意想不到的并发症, 特别是在需要几个步骤的治疗过程中.
Yet physicians tend to 有 unrealistic expectations of multiple step medical procedures, 根据 University of Utah Health researchers 和 their collaborators. They say inflated estimates of success could adversely influence treatment decisions 和 lead to unintended harm to patients.
总共, nearly 8 out of 10 physicians surveyed believed the chances of obtaining a desired outcome after a medical procedure were greater than the probability of the success of one or more steps leading to that outcome.
这项研究发表在 JAMA网络开放， highlights a serious logical disconnect among physicians who fail to consider that each step in the process has its own risks that can diminish the chances of success for the desired medical outcome, 根据 Scott Aberegg， M.D., 他是uu Health的重症监护肺病专家.
“很多时候, doctors act as though the stars align more frequently than they actually do,阿伯雷格说. "They tend to focus on the desired outcome rather than the actual chances of success involved in each intermediary step. 大发娱乐不能再这样做医疗决定了. 大发娱乐需要把它们建立在更现实的期望之上."
这项研究, conducted by Aberegg; Hal Arkes, Ph.D., of The Ohio State University; 和 Kevin Arpin, Ph.D., a forensic specialist at Travelers 保险 company in Connecticut, sought to determine how frequently a phenomenon called conjunction fallacy happens in medicine.
Conjunction fallacy occurs when a person believes that a combination of events or statements is more likely than any one of its individual components.
假设, 例如, that a doctor notices skin growth on a patient 和 has 80% suspicion that it is 癌症ous. There’s also an 80% chance that the pathologist sees 癌症 on a biopsy specimen in the lab. The false assumption—the conjunction fallacy––would be that there’s more than an 80% chance that the pathologist will see 癌症 on the patient's biopsy specimen.
在现实中, the probability that the pathologist will see 癌症 on this patient's biopsy is 64%, 因为首先病人必须 有 癌症 然后 病理学家必须在活组织检查中看到.
"Many physicians simply aren’t good at calculating probability,阿伯雷格说. "As a result, they commonly miss opportunities to make better treatment decisions."
在研究中, Aberegg 和 colleagues asked 215 obstetricians 和 pulmonologists to evaluate scenarios that they might encounter while caring for patients.
例如, 在一个场景中, obstetricians were confronted with a 29-year-old pregnant woman in labor. 然而, the child is not positioned properly for a vaginal birth. 在这种情况下, the doctors were asked to estimate the probability that the child would move into a deliverable position 和 出生时不需要剖腹产.
整体, 78% of the physicians who evaluated one of three scenarios in the survey estimated that the probability of the desired outcome would be greater than the likelihood of the two individual events required for it to occur. 这在数学上是不可能的，Aberegg说.
"Our study shows that if you poorly estimate the probability of two events needing to happen to get the result you desire, then you could be putting your patients at unnecessary risk,阿伯雷格说. “在分娩的情况下, you could end up waiting around for a long time for that baby 和 end up having to do a C-section anyway. 这种延迟可能对母亲和孩子都有害."
All of the physicians who participated in the surveys had an average of 25 years of experience. Yet this expertise did not appear to prevent them from opting for the conjunction fallacies presented in the study. 然而, this isn’t too surprising since previous research found that nearly 50% of medical students are prone to these types of probability errors, 据阿伯拉格说.
"There are enormous opportunities in medical education to improve the curriculum in terms of teaching the importance of probability in medical settings,阿伯雷格说. "Numbers are the most reliable source of correct decisions in medicine."
Aberegg urges practicing physicians to not only rely on their experience but also do their best to stay up-to-date on the latest probability research published in medical journals about various conditions 和 procedures.
Among the study’s limitations is that the participants were asked for written responses that might 有 been different had they been providing care to real patients
然而, Aberegg believes the study could 有 broad implications.
“大发娱乐的结果非常强劲，”阿伯拉格说. "We’re confident that they represent a generalized phenomenon in medicine. I’m interested in further cataloging more examples so that the full breadth of this potential problem can be exposed 和 hopefully resolved."
####
除了Aberegg， Hal Arkes, Ph ..D., of The Ohio State University; 和 Kevin Arpin, Ph.D., a forensic specialist at Travelers 保险 company in Connecticut; contributed to this study.
这项研究, "Analysis of Physicians' Probability Estimates of a Medical Outcome Based on a Sequence of Events,”出现在 JAMA网络开放. 这项研究是由Aberegg， Arkes和Aprin自己资助的.