Hindsight Bias

Hindsight bias, also known as the knew-it-all-along effect or creeping determinism, is the inclination, after an event has occurred, to see the event as having been predictable, despite there having been little or no objective basis for predicting it. It is a multifaceted phenomenon that can affect different stages of designs, processes, contexts, and situations. Hindsight bias may cause memory distortion, where the recollection and reconstruction of content can lead to false theoretical outcomes. It has been suggested that the effect can cause extreme methodological problems while trying to analyze, understand, and interpret results in experimental studies. A basic example of the hindsight bias is when, after viewing the outcome of a potentially unforeseeable event, a person believes he or she “knew it all along”. Such examples are present in the writings of historians describing outcomes of battles, physicians recalling clinical trials, and in judicial systems trying to attribute responsibility and predictability of accidents.[4]

Hindsight bias has both positive and negative consequences. The bias’s also play a role in the process of decision-making within the medical field.

Positive

Positive consequences of hindsight bias is an increase in one’s confidence and performance, as long as the bias distortion is reasonable and does not create overconfidence. Another positive consequence is that one’s self-assurance of their knowledge and decision-making, even if it ends up being a poor decision, can be beneficial to others; allowing others to experience new things or to learn from those who made the poor decisions.[31]

Negative

Hindsight bias decreases one’s rational thinking because of when a person experiences strong emotions, which in turn decreases rational thinking. Another negative consequence of hindsight bias is the interference of one’s ability to learn from experience, as a person is unable to look back on past decisions and learn from mistakes. A third consequence is a decrease in sensitivity toward a victim by the person who caused the wrongdoing. The person demoralizes the victim and does not allow for a correction of behaviors and actions.[31]

Medical decision-making

Hindsight bias may lead to overconfidence and malpractice in regards to doctors. Hindsight bias and overconfidence is often attributed to the number of years of experience the doctor has. After a procedure, doctors may have a “knew it the whole time” attitude, when in reality they may not have actually known it. In an effort to avoid hindsight bias, doctors use a computer-based decision support system that help the doctor diagnose and treat their patients correctly and accurately.[32

Health care system

Accidents are prone to happen in any human undertaking, but accidents occurring within the healthcare system seem more salient and severe due to their profound effect on the lives of those involved, sometimes resulting in the death of a patient. In the healthcare system, there are a number of methods in which specific cases where accidents happened are reviewed by others who already know the outcome of the case. These methods include morbidity and mortality conferences, autopsies, case analysis, medical malpractice claims analysis, staff interviews, and even patient observation. Hindsight bias has been shown to cause difficulties in measuring errors in these cases.[42] Many of these errors are considered preventable after the fact, clearly indicating the presence and importance of a hindsight bias in this field. There are two sides of debate in how these case reviews should be approached to best evaluate past cases: the error elimination strategy and the safety management strategy.[4] The error elimination strategy aims to find the cause of errors, relying heavily on hindsight (therefore more subject to the hindsight bias).[4] The safety management strategy relies less on hindsight (less subject to hindsight bias) and identifies possible constraints during the decision making process of that case. However, it is not immune to error.[4]

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