Understanding patients' decisions. Cognitive and emotional perspectives

Objective. —To describe ways in which intuitive thought processes and feelings may lead patients to make suboptimal medical decisions. Design. —Review of past studies from the psychology literature. Results. —Intuitive decision making is often appropriate and results in reasonable choices; in some situations, however, intuitions lead patients to make choices that are not in their best interests. People sometimes treat safety and danger categorically, undervalue the importance of a partial risk reduction, are influenced by the way in which a problem is framed, and inappropriately evaluate an action by its subsequent outcome. These strategies help explain examples where risk perceptions conflict with standard scientific analyses. In the domain of emotions, people tend to consider losses as more significant than the corresponding gains, are imperfect at predicting future preferences, distort their memories of past personal experiences, have difficulty resolving inconsistencies between emotions and rationality, and worry with an intensity disproportionate to the actual danger. In general, such intangible aspects of clinical care have received little attention in the medical literature. Conclusion. —We suggest that an awareness of how people reason is an important clinical skill that can be promoted by knowledge of selected past studies in psychology. (JAMA. 1993;270:72-76)