Changing attitudes to 'the change'

Abstract

BACKGROUND In order to practise efficiently, experienced doctors use heuristics (decision making shortcuts). In most cases decision making shortcuts improve the service we offer, allowing us to make appropriate decisions more quickly. However, occasionally shortcuts can mislead. It is important to reflect on the shortcuts we use so as to reduce the risk of mistakes. OBJECTIVE This article examines the potential pitfalls of decision making shortcuts using hormone therapy (HT) in menopause as an example. DISCUSSION Recent randomised controlled trials have changed the thinking on the risk-benefit ratio for HT. The previously assumed long term health benefits of HT for women during and beyond menopause resulted from shortcuts in decision making including ‘association means causation’ (observational data), ‘experts know best’ (the experience of gynaecologists seeing women with severe menopausal symptoms is applied to all women) and ‘a biological theory to explain a phenomenon makes it likely to be true’ (oestrogen has a positive effect on lipid profiles and so was assumed to be cardioprotective).