The situation
Numerous decisions are made in hospital settings in order to improve the health of patients. Therefore, it is necessary to provide adequate information so that optimal and rational decisions are made. I experienced a difficult decision-making situation while working as a unit assistant at the King Hussain Hospital. A patient who had been admitted for three months needed an emergency operation that would either save or end his life. The decision was difficult to make because the patient had been in a coma for sixteen hours and his family members were inaccessible.
In addition, limited time necessitated rash decision making. Any delays would have serious consequences on his health according to the assessment of the doctor. The doctor had to decide whether to operate on the patient or wait until his family members could be contacted. It is unethical and illegal to treat patients without their consent or the consent of their family members in case they are unable to make rational decisions. The seriousness of the situation prompted the doctor to make a decision that had dire consequences. He authorized the operation with the hope that it would save the patient’s life. Factors that influenced the decision included the state of the patient’s health, previous outcomes of similar emergency operations, superficial analysis of information, nurses’ responsibility to the wellbeing of the patient, emotional thinking, limited time, and limited information. Unfortunately, the patient succumbed to injuries and died owing to low immunity and poor body condition.
Analysis
According to availability heuristic, people make decisions based on the ease of recalling previous instances that had certain outcomes. Eight months before the occurrence of the aforementioned situation, two patients who had similar problems underwent successful operations and regained their health. The doctor operated on them without their consent because they were in the intensive care unit, there was unlimited time to save them, and their families were unreachable. In both cases, the patients survived and regained their health. These instances played a key role in informing the decision of the doctor and the nurses.
The case under consideration was different because the patient had not shown any significant improvements since admission and he had other illnesses that weakened his immunity. The doctor was influenced by the outcomes of past events and assumed that the cases were similar. As a result of their assumptions, they failed to conduct a thorough assessment of the patient’s health condition. Confirmation heuristic is the tendency to lean towards a certain result by selectively using information that supports one’s beliefs (Fitzgerald, 2013). The doctor and the nurses made the decision by using information that only validated their decision. They were so blinded by their limited interpretation that they ignored important facts that could have avoided the tragedy.
The nurses were emotional regarding the patient’s situation because of the great suffering he was undergoing. They felt that it was their responsibility to preserve and improve his health despite the fact that he was in an unstable condition that endangered his life in case he was operated on. According to affect heuristic, people make decisions based on emotions that dominate their thinking during the decision-making process (Fitzgerald, 2013). Allowing emotions to influence decision-making is risky because affective evaluations exclude high-level reasoning that is important in the avoidance of biases. Decision making comprises three main components namely bias, truth, and random errors (Bazerman, 2001). Truth refers to any information presented in order to aid in making a decision. Inadequate information was provided to the doctor because of superficial assessment of the patient’s health.
Thorough assessment could have provided adequate information for a more rational decision. The doctor failed to use all the information provided especially that which pointed at the patient’s low immunity. Selective consideration of information introduced biases that encouraged irrationality. The doctor’s decision was also influenced by anchoring effect. Anchoring effect occurs when a decision is made based on the value given to the first piece of information that is received or considered (Ariely, 2008). The information that the doctor first received was of the successful operation of two patients who were in the intensive care unit. This information created the anchoring effect that resulted in a biased decision. In addition, any information that was considered thereafter was skewed towards supporting the hypothesis that the success of past events provided proof that the current event would be successful too.
The operation was very risky and the probability of death was high. However, biases that originated from confirmation heuristic, emotional heuristic and anchoring effect clouded the doctor’s judgment. Risk is an important factor to consider when making choices. Decisions are made under conditions of uncertainty because of the inability to accurately predict the outcome of one’s actions (Gil-Aluja, 2013). The procedure could have either preserved the patient’s health or killed him. The expected utility theory empowers individuals to make rational decisions in situations that the outcomes of certain actions are unclear. According to the theory, the action with the highest expected utility should be chosen after careful analysis (Gil-Aluja, 2013). It was clear that operating on the patient was both uncertain and highly dangerous.
On the other hand, undertaking a risky treatment procedure without the consent of the patient or his family was unethical. However, the doctor and nurses ignored this important information and allowed heuristics and biases to influence their decision. Human beings are imperfect thinkers because of their limited processing capabilities, limited time, and unavailability of adequate information (Fitzgerald, 2013). Bounded rationality refers to the concept that decision making is affected by the availability of information, cognitive limitations, and the time available for a resolution to be made (Fitzgerald, 2013). The doctor and nurses had limited information and time. Time was limited because the patient needed an emergency operation based on the assessment of the nurses. On the other hand, information was limited because the nurses failed to conduct a thorough evaluation that could have revealed the real state of the patient’s health.
Reflection
The major components of rationality include logic, probability theory, and rational choice theory (Ariely, 2008). These components were not properly applied in the aforementioned decision-making process. If I were the decision maker in the above situation, I would have made a better decision by avoiding the various heuristics and biases that influenced the doctor and nurses. First, I would have asked for a thorough appraisal report regarding the patient’s health condition because operating on a patient with poor health and low immunity is highly risky. This would have provided sufficient information that would have improved the rationality of the decision. According to bounded rationality, poor decisions result from inadequate information and limited time (Stanovich, 2010). In the above situation, the doctor thought that he had limited time because the nurses were wrong regarding the necessity of the emergency operation. The doctor took a reasoning shortcut that resulted in the death of the patient. Proper understanding of the importance of adequate information would have resulted in an optimal and rational decision (Gil-Aluja, 2013).
I would have avoided the anchoring effect by analyzing the information wholly without considering certain pieces as more important than others. The anchoring effect caused by the initial information that the doctor and nurses considered affected their decision. Secondly, I would put rationality before emotions. Bounded rationality comprises two schools of thought namely the emotional and rational schools (Stanovich, 2010). The doctor applied concepts of the emotional school of thought, hence the fast, effortless, and sub-optimal decision. I would have applied rationality by analyzing the information provided thoroughly, slowly, and consciously. The emotional school of thought is prone to errors and bias because of its various limitations (Kahneman, 2011). For example, decision-making relies on intuition and thus it happens unconsciously and automatically. Allowing emotions to affect decision-making leads to severe errors because heuristics and biases exert their influence and cloud rational judgment.
The doctor’s decision was also influenced by availability heuristic. Past instances of successful emergency operations that were easy to recall convinced the doctor and the nurses that the patient would survive the operation. If I were the decision-maker, I would have refrained from treating the three cases as mutually exclusive. I would consider them individually and analyze the circumstances surrounding each situation. Past events are not a reflection of present or future outcomes (Bazerman, 2001). Therefore, treating the case independently would have helped to make a more rational decision. The patient’s past records provided sufficient proof that the patient was in poor health and was unsuitable for an operation. However, the doctor ignored the risk and carried out the procedure. Applying rational thinking techniques would help to determine whether the patient’s state of health was appropriate for such a risky operation. In addition, I would use the data to estimate the risk involved and thus refrain from conducting the operation. In addition, I would have used alternative treatment remedies.
References
Ariely, D. (2008). Predictably Irrational: The Hidden Forces that Shape our Decisions. New York: Harper Collins.
Bazerman, M. H. (2001). Judgment in Managerial Decision Making. Wiley: New York.
Fitzgerald, M. (2013). Managing Under Uncertainty: A Qualitative Approach to Decision Making, 2nd Ed. New York: Pearson.
Gil-Aluja, J. (2013). Handbook of Management under Uncertainty. New York: Springer Science & Business Media.
Kahneman, D. (2011). Thinking, Fast and Slow. New York: Penguin Books.
Stanovich, K. E. (2010). Decision Making and Rationality in the Modern World. London: Oxford University Press.