Decision-Making Cognitive Process: Let's not Forget That Healthcare Professionals are Human

Introduction

With computers and the interest in information processing, a new image of man begins to emerge. In the 1950s, studies of Broadbent (1954), continuing the Cherry (1953) model, culminate in the model of human thought processes. A model that began with the information received by the senses, but concentrated on a new and important feature: the individual has a limited capacity for receiving and storing information (Gardner, 2003).

These results were related to the work of George Miller. Miller (1956) in “The magical number seven, plus or minus two: some limits on our capacity for processing information”, when referring to classification and coding, indicates that there are limitations to the ability to process sensory signals on the order of about seven. At the same time, Bruner led the “Cognition Project” at Harvard. Faced with the observations of human performance in tasks of formation and acquisition of concepts, Bruner, Goodnow and Austin (1956) suggest that individuals suffered a state of “cognitive strain” and tried to reduce it through strategies of simplification.

In the study of decision-making, the classical view of behavioral appropriateness or rationality was also challenged by psychological reasons. One major example was Simon's theory (1957) of “bounded rationality”, in which it is proposed that cognitive limitations lead decision-makers to construct simplified models for dealing with the world. In the same study, Simon (1957) suggests several cognitive strategies, the average, the sum and subtraction, to explain the behavior of different economic agents. The best-known example is the “satisfaction” one, which explains the behavior of consumers looking for a “good enough” option in an uncertain environment, where the search for alternatives is costly. To satisfy is a heuristic decision which involves choosing the first alternative that meets its minimum requirements. To satisfy is simple in terms of cognitive operators; therefore, it makes smaller demands to the scarce mental resources. However, it can lead to sub-optimal behavior, given that finding an acceptable option, the search and evaluation of other alternatives, possibly better ones, ceases.

When asked by Gigerenzer about why bounded rationality is not the same as irrationality, Simon answered with an analogy. “Bounded rationality is like scissors: the mind is a blade and the structure of the environment is the other blade. To understand the behavior, we have to look at both and in how they fit” (Simon, 1990, p. 7; Gigerenzer, 2004, p. 397). In other words, in order to assess the cognitive strategies as rational or irrational, one must also consider the environment because a strategy is rational or irrational only with respect to a physical or social environment (Simon, 1990). Thus, models of bounded rationality bring the reality and consider how human with little time and knowledge behave. This term, coined by Simon (1955) is associated with three distinct programs: the study of optimization under constraints, the study of cognitive illusions and the study of fast and frugal heuristics.

Marewsky & Gigerenzer (2012) mention that doctor’s decisions, for example, are made under uncertain conditions as without knowing precisely whether a diagnosis is correct or whether a treatment will actually cure a patient, and often under time constraints. It has been demonstrated that levels of cognitive function are compromised as stress and fatigue levels increase (Bourne & Yaroush, 2003) as is often the norm in certain complex, high-intensity fields of work (Hales & Pronovost, 2006). The Institute of Medicine estimates that medical errors cause between 44000 and 98000 deaths annually in the United States alone, resulting in US$17 to 29 billion in costs annually (Institutes of Medicine, 1999). Therefore, heuristics emerge as cognitive strategies that can provide good solutions to complex problems under time and cognitive ability constraints (Kattan, 2009) where decision making unconsciously use constraints to simplify the information as a trigger or shortcut to certain information that follows some pattern for the decision maker, thus exerting influence in the judgment of the information and in the decision making.