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Articles | Behavioural science

Rational irrationalists

The hidden truths about how doctors make decisions

By Lisa M Lee & Dr. Hal Willaby

The frequent absurdity and enduring irrationality of the human condition has long been a subject of inquiry by philosophy, literature and other traditional humanities

Ward, Joseph J

Humans can be, and frequently are, irrational creatures.

Irrationality is one of the basic premises of the field of behavioural economics. It is a concept supported by years of work in psychology and in the broader field of behavioural science. It feels intuitive – who hasn’t, at some point, looked at what other people are doing and thought ‘What on earth are you thinking?’ Marketers have known for years that consumer purchase decisions can be heavily influenced by ‘irrational’ emotional triggers or behavioural cues that have nothing to do with utility. By and large, we accept this – people can and do act irrationally, and they can certainly make irrational decisions.

However, in real life, what we actually believe is that SOME people (i.e. ‘the average Joe’) can and do act irrationally. What we do not believe, or even consider, is that people in positions of expertise, leadership or power can also make irrational decisions.

Medical doctors, for example, are not immune to irrational decision-making. In fact, there is a large and growing body of work to show that doctor decision-making can be swayed by factors that seem, on the face of things, to be incredibly esoteric and random.

In behavioural economics terms, doctors are, like the rest of us, subject to heuristics (mental short-cuts) and the biases that stem from them. Consider Figure 1 overleaf for an example:

Obstetricians’ likelihood of recommending a caesarean section can be swayed by how information on the dilation of cervix and the duration of labour is presented (2).

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