UNDERSTANDING PATIENTS DECISIONS - COGNITIVE AND EMOTIONAL PERSPECTIVES

Objective.-To describe ways in which intuitive thought processes and f eelings may lead patients to make suboptimal medical decisions. Design .-Review of past studies from the psychology literature. Results.-Intu itive decision making is often appropriate and results in reasonable c hoices; in some situations, however, intuitions lead patients to make choices that are not in their best interests. People sometimes treat s afety and danger categorically, undervalue the importance of a partial risk reduction, are influenced by the way in which a problem is frame d, and inappropriately evaluate an action by its subsequent outcome. T hese strategies help explain examples where risk perceptions conflict with standard scientific analyses. In the domain of emotions, people t end to consider losses as more significant than the corresponding gain s, are imperfect at predicting future preferences, distort their memor ies of past personal experiences, have difficulty resolving inconsiste ncies between emotions and rationality, and worry with an intensity di sproportionate to the actual danger. In general, such intangible aspec ts of clinical care have received little attention in the medical lite rature. Conclusion.-We suggest that an awareness of how people reason is an important clinical skill that can be promoted by knowledge of se lected past studies in psychology.