Medical care is rarely straightforward, whether a woman is giving birth or a man is having a cancer biopsy. During multi-step therapies, complications can emerge at any time.

However, a recent study by experts from the University of Utah Health and their partners found that physicians frequently have exaggerated expectations about the effectiveness of complicated medical treatments.

Inflated success predictions, according to them, could have a negative impact on treatment choices and result in unintended damage to patients.

Overall, almost 8 out of 10 doctors who responded to the study thought there was a higher possibility of getting the desired result from an operation than there was of one or more steps leading to that result being successful.

According to Scott Aberegg, M.D., a critical care pulmonologist at U of U Health, the study, which is published in JAMA Network Open, highlights a serious logical disconnect among doctors who neglect to consider that each step in the process has its own risks that can lessen the chances of success for the desired medical outcome.

Aberegg claims that physicians “All too often, doctors act as though the stars align more frequently than they actually do”.  They frequently ignore the odds of success inherent in each intermediate step in favor of the desired conclusion. That is not how we can continue to make medical decisions. They must be based on more reasonable expectations, according to the authors.

In order to ascertain how frequently phenomena known as conjunction fallacy occurs in medicine, Aberegg, Hal Arkes, Ph.D., of The Ohio State University, and Kevin Arpin, Ph.D., a forensic specialist at Travelers Insurance in Connecticut, undertook the study.

The conjunction fallacy is when someone thinks that a set of events or statements together are more likely than any of them on their own.

Say, for example, a doctor sees growth on a patient’s skin and has an 80% chance that it is cancerous. Additionally, there is an 80% chance that a pathologist will find cancer on a biopsy specimen in the lab. The conjunction fallacy would lead one to believe that there is a greater than 80% chance that the pathologist will detect cancer on the patient’s biopsy samples.

In reality, there is a 64% chance that the pathologist will find cancer on this patient’s biopsy. First, the patient has to have cancer, and then the pathologist has to be able to see it on the biopsy.

According to Aberegg, “many physicians simply aren’t good at calculating probability. As a result, they commonly miss opportunities to make better treatment decisions .”

In their research, Aberegg and colleagues polled 215 pulmonologists and obstetricians about potential patient care scenarios.

In one case, obstetricians had to deal with a pregnant woman who was 29 years old and in labor. The kid, however, is not in the ideal position for a vaginal birth. In this instance, the doctors were asked to determine the likelihood that the baby will shift into a deliverable position and give birth vaginally.

Overall, 78 percent of the doctors who assessed one of the three scenarios in the survey said that the likelihood of the desired result would be higher than the odds of the two separate occurrences needed to make it happen. Aberegg claims that this is a mathematical impossibility.

“According to Aberegg’s study, “if you poorly estimate the probability of two events needing to happen to get the result you desire, then you could be putting your patients at unnecessary risk.” Aberegg adds, “In the case of the childbirth scenario, you could end up waiting around for a long time for that baby and end up having to do a C-section anyway. That delay could be harmful for both mother and child.”

The average experience of the doctors who took part in the questionnaires was 25 years. However, their knowledge did not seem to stop people from choosing the study’s conjunction fallacies. Aberegg claims that this shouldn’t come as much of a surprise because other studies have shown that around 50% of medical students are prone to these kinds of probability errors.

“There are enormous opportunities in medical education to improve the curriculum in terms of teaching the importance of probability in medical settings,” Aberegg adds. “Numbers are the most reliable source of correct decisions in medicine.”

Aberegg exhorts practicing physicians to not just rely on their expertise but also make every effort to stay current on the most recent probability research about various ailments and procedures published in medical journals.

The fact that the participants were asked to write responses to questions that would have been different had they been giving care to actual patients is one of the study’s limitations.

Aberegg thinks the discovery could have broad ramifications, though.

“Our results are very strong,” Aberegg adds. “We’re confident that they represent a generalized phenomenon in medicine. I’m interested in further cataloging more examples so that the full breadth of this potential problem can be exposed and hopefully resolved.”

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