Clinicians' cognitive biases: A potential barrier to implementation of evidence-based clinical practice

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.