Rationality in medical treatment decisions: is there a sunk-cost effect?

OBJECTIVE: To assess residents' propensity to display the sunk-cost effect, an irrational decision-making bias, in medical treatment decisions; and to compare residents' and undergraduates' susceptibility to the bias in non-medical, everyday behaviors. DESIGN: Cross-sectional, in-person survey. SETTING: Louisiana State University, two locations: Medical Center-Baton Rouge and Main Campus-Psychology Department. PARTICIPANTS: Internal medicine and family practice residents (N = 36, Mdn age = 27) and college undergraduates (N = 40, Mdn age = 20). MEASUREMENTS AND MAIN RESULTS: Residents evaluated medical and non-medical situations that varied the amount of previous investment and whether the present decision maker was the same or different from the person who had made the initial investment. They rated reasons both for continuing the initial decision (e.g., stay with the medication already in use) and for switching to a new alternative (e.g., a different medication). There were two main findings: First, the residents' ratings of whether to continue or switch medical treatments were not influenced by the amount of the initial investment (p's>0.05). Second, residents' reasoning was more normative in medical than in non-medical situations, in which it paralleled that of undergraduates (p's<0.05). CONCLUSIONS: Medical residents' evaluation of treatment decisions reflected good reasoning, in that they were not influenced by the amount of time and/or money that had already been invested in treating a patient. However, the residents did demonstrate a sunk-cost effect in evaluating non-medical situations. Thus, any advantage in decision making that is conferred by medical training appears to be domain specific.

A comparison of item and source forgetting.

The purpose of the present research was to compare memory for an item with memory for the item's source. Experiment 1 investigated discrimination between two external sources: each item in a list of words was spoken in either a male or a female voice. Subjects received a test of item recognition and a test of source monitoring at each of four delay intervals (immediate, 30 min, 48 h, 1 week). In contrast with previous research, no evidence of differential forgetting rates for item and source information was found. With delay intervals of 0 and 48 h, Experiment 2 replicated Experiment 1 while adding a reality monitoring condition that required discrimination between an internal (i.e., self-generated) and an external source. Subjects were better at making internal-external discriminations than at making external-external discriminations, but both types of source monitoring declined at the same rate as memory for the items themselves.

Rationality in medical decision making: a review of the literature on doctors' decision-making biases.

The objectives of this study were to describe ways in which doctors make suboptimal diagnostic and treatment decisions, and to discuss possible means of alleviating those biases, using a review of past studies from the psychological and medical decision-making literatures. A number of biases can affect the ways in which doctors gather and use evidence in making diagnoses. Biases also exist in how doctors make treatment decisions once a definitive diagnosis has been made. These biases are not peculiar to the medical domain but, rather, are manifestations of suboptimal reasoning to which people are susceptible in general. None the less, they can have potentially grave consequences in medical settings, such as erroneous diagnosis or patient mismanagement. No surefire methods exist for eliminating biases in medical decision making, but there is some evidence that the adoption of an evidence-based medicine approach or the incorporation of formal decision analytic tools can improve the quality of doctors' reasoning. Doctors' reasoning is vulnerable to a number of biases that can lead to errors in diagnosis and treatment, but there are positive signs that means for alleviating some of these biases are available.

Choosing a doctor: an exploratory study of factors influencing patients' choice of a primary care doctor.

We assessed the relative importance healthcare consumers attach to various factors in choosing a primary care doctor (PCD) in a cross-sectional, in-person survey. Three survey locations were used: doctors' offices, a public shopping area, and meetings of a women's organization. A total of 636 community residents, varying across major demographic categories, participated. Participants completed a 23-item survey, designed to assess which factors consumers perceive as most relevant in choosing a PCD. Participants perceived professionally relevant factors (e.g. whether the doctor is board certified, office appearance) and management practices (e.g. time to get an appointment, evening and weekend hours) as more important than the doctor's personal characteristics (race, age, gender, etc.). Participants' own characteristics bore little relationship to the perceived importance of doctor characteristics. Factors patients perceive as most important to their choice of a PCD are also those that have the greatest effect on the quality of healthcare they will receive. However, they do not always have access to this information. A better understanding of the factors that influence people's choice of a PCD can contribute to efforts to provide them with the resources to make well-informed decisions in selecting among healthcare options.

The credibility of recovered memory testimony: exploring the effects of alleged victim and perpetrator gender.

OBJECTIVE: The purpose was to explore the effects of victim/complainant and perpetrator/defendant gender on the impact of recovered memory testimony in criminal sexual abuse trials. METHOD: A jury simulation methodology was used. Two hundred forty-six participants read a summary of a sexual abuse trial in which the following three variables were manipulated: the complainant's gender, the defendant's gender, and whether the complainant's memory of the alleged abuse had been "recovered" or remembered all along. Participants reached a verdict and rated the culpability and credibility of the parties. RESULTS: Compared to a case where the memory of the abuse had always been remembered, recovered memory testimony led to lower perceptions of the defendant's culpability and higher perceptions of the defendant's credibility. In addition, the complainant with recovered memory was viewed as less credible and less likely to be telling the truth. These effects of testimony type (i.e., recovered vs. remembered) were qualified by an interaction with complainant and defendant gender, such that testimony type exerted an effect in cases of alleged heterosexual but not homosexual abuse. CONCLUSION: The results suggest that mock jurors' judgments in sexual abuse cases reflect their stereotypes about sexual abuse and expectations regarding the relative likelihood of repression in various circumstances.

Registered Replication Report: Schooler and Engstler-Schooler (1990).

Trying to remember something now typically improves your ability to remember it later. However, after watching a video of a simulated bank robbery, participants who verbally described the robber were 25% worse at identifying the robber in a lineup than were participants who instead listed U.S. states and capitals-this has been termed the "verbal overshadowing" effect (Schooler & Engstler-Schooler, 1990). More recent studies suggested that this effect might be substantially smaller than first reported. Given uncertainty about the effect size, the influence of this finding in the memory literature, and its practical importance for police procedures, we conducted two collections of preregistered direct replications (RRR1 and RRR2) that differed only in the order of the description task and a filler task. In RRR1, when the description task immediately followed the robbery, participants who provided a description were 4% less likely to select the robber than were those in the control condition. In RRR2, when the description was delayed by 20 min, they were 16% less likely to select the robber. These findings reveal a robust verbal overshadowing effect that is strongly influenced by the relative timing of the tasks. The discussion considers further implications of these replications for our understanding of verbal overshadowing.

The revelation effect in frequency judgment.

In three experiments, we explored the revelation effect in a frequency judgment task. Participants estimated the frequency of words that had been presented one, two, four, or eight times. At test, half the words were revealed by completing word fragments, and half were presented intact. Estimated frequencies were reliably higher for revealed than for intact words, and in two of the three experiments, the revelation effect became larger as actual frequency increased. A revelation effect was obtained whether the revealed word was the same as (Experiment 1) or different from (Experiment 2) the word judged for frequency. Frequency estimates were higher for more distorted test items (Experiment 3).

Visual distinctiveness can enhance recency effects.

Experimental efforts to meliorate the modality effect have included attempts to make the visual stimulus more distinctive. McDowd and Madigan (1991) failed to find an enhanced recency effect in serial recall when the last item was made more distinct in terms of its color. In an attempt to extend this finding, three experiments were conducted in which visual distinctiveness was manipulated in a different manner, by combining the dimensions of physical size and coloration (i.e., whether the stimuli were solid or outlined in relief). Contrary to previous findings, recency was enhanced when the size and coloration of the last item differed from the other items in the list, regardless of whether the "distinctive" item was larger or smaller than the remaining items. The findings are considered in light of other research that has failed to obtain a similar enhanced recency effect, and their implications for current theories of the modality effect are discussed.

Maternal and nutritional contributions to infant rats' activational responses to ingestion.

Infant rats deprived of food, maternal care, and the opportunity to suckle display a dramatic behavioral activation and vigorously ingest when provided milk through oral cannulas. These experiments assessed which components of deprivation are important in producing these responses to milk. Nutritional deprivation alone, with or without the presence of an active maternal female, appears to be sufficient to produce ingestion. Behavioral activation, on the other hand, appears to require both nutritional deprivation and deprivation from a maternal female. The effect of maternal stimulation on later behavioral reactivity was not a function of the pups' opportunity to suckle. However, active maternal stimulation was more effective in preventing activation than was passive maternal stimulation (e.g., thermotactile and olfactory stimulation). Stimulation provided by an active, nonlactating mother was effective in preventing behavioral activation, but the effect was short-lived, lasting only 2 hr after the pup was removed from the mother's care. This series of studies thus reveals that identified components of maternal separation have dissociable effects on appetitively motivated behaviors in infant rats.