Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, October 6th, 2014
Three Reasons Surgeons Make Poor Decisions
James G. Wright, M.D., M.P.H., surgeon-in-chief at the Hospital for Sick Children in Toronto, is responsible for six surgical divisions. He has had ample opportunity to study and closely observe how surgeons come to a decision. His conclusion? There is a lot happening at the subconscious level. Dr. Wright, an orthopedic surgeon, tells OTW, “Most of us assume that because we are doing evidence-based medicine that the evidence will actually be used. This is not necessarily so, however, because the surgeon’s decision making process intervenes.”
“There appear to be three issues which come to bear when surgeons are trying to make a decision. The first is that surgeons come to relatively firm decisions and aren’t good at integrating new information. We are rather entrenched in our ways of thinking and despite new information/variations on what we know, we have trouble changing mindsets. Let’s say someone comes up with a great answer to an issue—something that should solve a controversy. The researcher publishes his or her work and promotes it through talks. We still see a slow uptake in the actual use of that information. I am pleased with what we are doing with evidence based orthopedics, but I don’t think we have considered the logical outplay of that, which is behavior change.”
“The second issue involves decision making at work. We did a ‘secret shopper’ study where we sent blinded total knee replacement patients into surgeons and family physicians’ offices. The result? Both types of doctors were more likely to recommend knee replacement to men than to women. The most likely explanation is that doctors form unconscious biases. When we asked these physicians if they treat men and women differently, they answered ‘No!’ But we know from employment research that when people go to job interviews those who are tall, more physically attractive, etc., fare better. These ubiquitous biases subtly influence behavior…and this is highly underappreciated.”
