Challenges in medical decision making and major cognitive errors in clinical reasoning: a historical perspective.

Decision making in medicine is a difficult and complex process subject to several possible cognitive errors. General empirical knowledge and a number of scientific studies show that, when making clinical decisions, physicians often prefer cognitive processes called heuristics. Heuristics indicates a typology of informal reasoning frequently useful on practical grounds but potentially generative of a number of biases and limits deriving from an imperfect integration of personal professional experience with patient data and information. Possible cognitive errors emerging from the adoption of heuristics are numerous and, to a certain extent, codified. In this contribution significant challenges of medical decision making and major cognitive errors are analyzed in a historical perspective. In the seventies the pioneering research of Kahneman and Tversky in the fields of heuristics and cognitive biases opened the way to a comprehensive analysis of the patterns of human judgment and the pathways of decision-making. A full comprehension of established risk factors for cognitive errors is a first mandatory step on the road of prevention and in the containment of such flaws, and this initial awareness should lead to the implementation of cognitive strategies targeted to the prophylaxis and reduction of cognitive errors. Taking into account the availability of current and future technological instruments functional for medical decision making, including artificial intelligence, the structural teaching of the correct and thoughtful adoption of such tools is called upon to become, with particular reference to the didactics of clinical reasoning, an integral part of modern medical education.