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Acute stroke, Bayes’ theorem and the art and science of emergency decision-making
  1. Mayank Goyal1,
  2. Kyle M Fargen2,
  3. Bijoy K Menon1
  1. 1Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Canada
  2. 2Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Mayank Goyal, Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada T2N2T9; mgoyal{at}

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Broadly speaking, the process of medical decision-making involves a series of cognitive steps. These include outlining the goal and desired outcome, comprehending the problem at hand (gathering data), evaluating the options that are available and developing alternatives, considering the pros and cons of each option, making the decision, taking action to implement the decision and, finally, learning from and reflecting on the decision that was generated. Often medical decision-making has a prolonged data gathering phase, given that diagnostic uncertainty may require a sequential progression of tests or imaging studies before a definitive diagnosis or plan of action can be reached. For this reason, a major component of the data gathering phase involves the reviewing of potential avenues for obtaining additional information through imaging, laboratory tests or other means. Furthermore, this decision process, and the cognitive steps that are undertaken, is highly influenced by previous experiences and the outcomes that were obtained in similar situations. A number of important cognitive biases that invariably impede accurate decision-making by physicians have been identified.1 However, with well-organized training, creation of algorithms and insightful introspection of the analytical processes being undertaken, the degree of bias created by overconfidence, heuristics or recent experiences can be effectively reduced.2 ,3 This process may have particular importance in fields where decisions are likely to have immediate and potentially irreversible consequences on human life, such as in the emergency room, intensive care unit or operating room.

There is increasing evidence to suggest that diagnostic errors can be reduced through controlled analytical thought or ‘debiasing’.2 ,3 Integral to this process is the recognition that most medical decisions (in fact, most decisions made in everyday life) are generated rapidly and unconsciously through the implicit system. Algorithms, protocols and checklists help to defend the practitioner from making poor …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.