Heuristic strategies for diagnostic decision making in emergency neurology

Authors

  • Kondrashin Aleksandr Aleksandrovich Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
  • Spiridonov Vladimir Feliksovich Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia
  • Kulesh Aleksey Aleksandrovich Perm State Medical University named after Academician E.A. Wagner of the Ministry of Health of the Russian Federation, Perm, Russia
  • Zamergrad Maxim Valerievich Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia; N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
  • Dyomin Dmitriy Alekseevich Federal Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Astrakhan, Russia

DOI:

https://doi.org/10.54359/qyx5e369

Keywords:

heuristic strategies, heuristic strategy "Take the best", clinical thinking, diagnostic decision making in medicine, diagnostic error, ecological rationality, expertise

Abstract

 

The aim of this study was to identify the heuristic strategies employed by emergency neurologists in making initial diagnostic decisions. Drawing on Gerd Gigerenzer’s theory of Simple Stopping Rules and One-Reason Decision Making [Gigerenzer et al., 1999; Todd & Gigerenzer, 2000], which posits that a decision between two or more alternatives can be made based on the value of a single cue, we tested the hypothesis that physicians apply the heuristic strategy Take The Best [Gigerenzer & Goldstein, 1996]. According to this strategy, in order to determine which of two diagnostic alternatives is more valid, one must: (a) examine cues in order of their validity, (b) stop searching once a cue discriminates between the alternatives, and (c) choose the alternative favored by that cue.

Twenty-three interviews were conducted via video conferencing with practicing neurologists of varying levels of professional experience. Participants were presented with clinical cases in the domain of emergency neurology and asked to request additional information in order to make a diagnosis. During the analysis of interview transcripts, cue-seeking statements were identified that indicated the evaluation of competing diagnostic hypotheses. Results showed that participants typically selected the diagnostic alternative supported by the first discriminative cue. This finding demonstrates that neurologists predominantly rely on the Take The Best heuristic strategy. Moreover, the use of this heuristic conferred a significant diagnostic accuracy advantage to expert clinicians compared to less experienced counterparts.

These findings underscore the importance of the Take The Best  heuristic in accurate diagnostic decision-making within emergency neurology. They also suggest the potential for developing interactive case-based training simulators with adjustable levels of difficulty, tailored to diagnosticians with varying qualifications. The diagnostic cases used in the current study, along with similar cases, can serve as material for such simulators.

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Author Biographies

  • Kondrashin Aleksandr Aleksandrovich, Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia

    PhD student, Faculty of Psychology, Institute of Social Sciences, Russian Presidential Academy of National Economy and Public Administration, Prospect Vernadskogo, 82, bldg. 1, 119571, Moscow, Russia.

  • Spiridonov Vladimir Feliksovich, Russian Presidential Academy of National Economy and Public Administration, Moscow, Russia

    Doctor of Psychology, Professor, Head of the Research Laboratory of Cognitive Studies, Institute of Social Sciences, Russian Presidential Academy of National Economy and Public Administration, Prospect Vernadskogo, 82, bldg. 1, 119571, Moscow, Russia.

  • Kulesh Aleksey Aleksandrovich, Perm State Medical University named after Academician E.A. Wagner of the Ministry of Health of the Russian Federation, Perm, Russia

    Doctor of Medical Sciences, Professor, Head of the Department of Integrative Medicine, Perm State Medical University named after Academician E.A. Wagner, Ministry of Health of the Russian Federation, Petropavlovskaya str., 26, 614990, Perm, Russia.

  • Zamergrad Maxim Valerievich, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Moscow, Russia; N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia

    Doctor of Medical Sciences, Professor of the Department of Neurology with a course in Reflexology and Manual Therapy, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation, Barrikadnaya str., 2/1, bldg. 1, 125993, Moscow, Russia. Leading Research Associate, Russian Gerontological Research and Clinical Center, Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, 1st Leonova str., 16, 129226, Moscow, Russia.

  • Dyomin Dmitriy Alekseevich, Federal Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Astrakhan, Russia

    PhD in Medicine, Neurologist, Federal Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Pokrovskaya Roscha str., 4, 414004, Astrakhan, Russia.

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Published

2025-09-24

Issue

Vol. 18 No. 102 (2025)

Section

Experimental and empirical research

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How to Cite

Kondrashin, A., Spiridonov, V., Kulesh, A., Zamergrad, M., & Dyomin, D. (2025). Heuristic strategies for diagnostic decision making in emergency neurology. Psychological Studies, 18(102), 5. https://doi.org/10.54359/qyx5e369