16 Jun 2022

Decision time for doctors

Junior doctors can struggle with decision-making in emergency departments because they worry about “looking silly” in front of senior colleagues, a study has found. A team from the Healthcare Safety Investigation Branch looked at missed or delayed diagnosis of conditions in A&E. They specifically examined cases of pulmonary embolism and focused on diagnostic decision-making using applied cognitive task analysis.

Interviews with medical staff found a number of factors which were common among expert level doctors. These included being aware of life-threatening conditions and seeking to rule them out, being comfortable in expressing doubt and seeking out peers to challenge their diagnosis.

Junior staff on the other hand often tried to fit symptoms to specific conditions and had a fear of making wrong a diagnosis. Some said they were afraid of “looking silly in front of a senior”. The study, which was presented at an online session of our Ergonomics & Human Factors 2022 conference, suggested looking at how younger staff can be supported in improving their decision-making.

HSIB investigator Nick Woodier, who presented the study, said: “Decision-making is a skill, commonly developed in healthcare through experience without formal training or opportunities to practise it.”

See Nick’s video about the study

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