Page 20 - Management Theory 2023-2024 Edition

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5. Theories of Human Inference

Theories of human inference can be used to evaluate and design educational methods that affect a physician’s
prescribing. The inference puts more emphasis on adverse or toxic reactions and effectiveness of drug therapy,
since these two criteria are important factors that affect the physician’s prescribing decisions. When prescribers
make inference, they use one or more types of judgmental heuristics.

What is judgmental heuristics? Heuristic is defined as a rule of thumb, simplification, or educated guess that
reduces or limits the search for solutions in domains that are difficult and poorly understood. Judgmental
heuristics is defined as an educated guess which helps to classify and interpret new information, and drive us to
make a final decision. We use these heuristics in our normal life constantly without realizing it. Most of the time
they are accurate; however sometimes they may lead to judgmental errors. There are four types of judgmental
heuristics that affect the prescriber’s judgment. They are:

1. Representativeness heuristics
2. Availability heuristics
3. Framing heuristics
4. Anchoring heuristics

1. Representativeness: This type of heuristic involves a similarity between events or objects. For example,
if a patient feels better after a drug is given, the prescriber may use judgment that the patient is cured,
but the improvement could be a result of a number of other factors such as improved diet, normal
fluctuation in the illness, decreased stress or using OTC therapies. Representativeness heuristic occurs
when a physician does not consider these other factors in the outcome of therapy. This would not stop
here; by using this judgment that the patient has been cured, the physician will prescribe the same drug
in the future (from his previous experience) to other patients if he encounters similarity of symptoms of
disease in patients.

2. Availability heuristics: This type of heuristic helps us judge frequency, probability and causality.
According to this type of heuristic, new information is accessed according to information that is more
readily available from memory. For example, a physician sees the same sort of symptom patterns
frequently in a series of patients and makes an inference that a new patient with similar symptoms has
the same illness. If proper clinical and laboratory tests are not used to verify the diagnosis, this could
result in diagnosis error and inappropriate prescribing.

Availability heuristic is affected by vividness. Vivid pictures, stories and actual patient cases may be
available more readily in memories and therefore affect the physician’s judgment. It is easier to recall
these images than statistics, graphs or figures when making a diagnosis. Prescribing can be affected by
these images through vividness.

3. Framing heuristics: This type of judgmental heuristic occurs when physicians use another alternative to
avoid an undesirable outcome. For example, a particular drug may cause cancer when used for a
prolonged time for 1 in 1000,000 patients. A prescribing physician may put more emphasis on
undesirable outcomes when making a prescribing decision, even though the drug has the best clinical
effects for the given diagnosis. The best example of framing is saccharine (sweetener) which was taken
off the market due to association with cancer in rats when given in large doses.

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