Heuristics and Cognitive Bias—What Can We Learn from Waking Up?

The world is complex. We have developed ways of understanding, interpreting and responding to this complex environment using shortcuts. These shortcuts reduce our cognitive load and thus enable us to detect potential threats and respond. These shortcuts are called heuristics and they are very powerful. Heuristics do reduce task complexity, facilitating rapid judgement and responses, but they also result in gaps between the normative behaviour predicted and the heuristically determined behaviour observed. Cognitive biasesCognitive bias can result from these shortcuts and interfere with good decision making. Heuristics are predominantly, but not exclusively, a System 1 tool. Although these heuristics do work well in the hands of experts, they can also be the source of prejudice, cognitive biasCognitive bias and, at times, bad decisions. I will review the main heuristics and cognitive biases I see relevant to surgerySurgery and suggest modifications to clinical audit as a result. I will also explore the literature on cognitive debiasing and apply it to the practice of surgery. Can we avoid the likely errors when making decisions using heuristics?