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How to make good-enough risk decisions

  • Andrew Carroll
Summary

Making decisions in the context of risk is an integral part of psychiatric work. Despite this, decision-making skills are rarely systematically taught and the processes behind decisions are rarely made explicit. This article attempts to apply contemporary evidence from cognitive and social psychology to common dilemmas faced by psychiatrists when assessing and managing risk. It argues that clinical decision-making should acknowledge both the value and limitations of intuitive approaches in dealing with complex dilemmas. After discussing the various ways in which clinical decision-making is commonly derailed, the article outlines a framework that accommodates both rational and intuitive modes of thinking, with the aim of optimising decision-making in high-risk situations.

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Copyright
Corresponding author
Dr Andrew Carroll, Centre for Forensic Behavioural Science, Monash University, 505 Hoddle Street, Clifton Hill, Victoria 3068, Australia. Email: andrew.carroll@med.monash.edu.au
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Declaration of Interest

None.

Footnotes
References
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Abelson, RP, Levi, A (1985) Decision making and decision theory. In Handbook of Social Psychology (3rd edn) (eds Lindzey, G, Aronson, E) 231309. Random House.
Andrews, DA, Bonta, J (2003) The Psychology of Criminal Conduct. Anderson.
Bechara, A, Damasio, H, Tranel, D et al (1997) Deciding advantageously before knowing the advantageous strategy. Science; 275: 1293–5.
Bell, D (1999) Ethical issues in the prevention of suicide in prison. Australian and New Zealand Journal of Psychiatry; 33: 723–8.
Bouch, J, Marshall, JJ (2005) Suicide risk: structured professional judgement. Advances in Psychiatric Treatment; 11: 8491.
Boucher, J, Osgood, CE (1969) The Pollyanna hypothesis. Journal of Verbal Learning and Verbal Behaviour; 8: 18.
Carson, D (1996) Developing models of risk to aid cooperation between law and psychiatry. Criminal Behaviour and Mental Health; 6: 610.
Dawes, RM, Faust, D, Meehl, PE (1989) Clinical versus actuarial judgment. Science; 243: 1668–74.
Del Mar, C, Doust, J, Glasziou, P (2006) Clinical Thinking. Blackwell.
Douglas, K, Skeem, JL (2005) Violence risk assessment. Getting specific about being dynamic. Psychology, Public Policy, and Law; 11: 347–83.
Elwyn, G, Edwards, A, Eccles, M et al (2001) Decision analysis in patient care. Lancet; 358: 571–4.
Faust, D (1986) Research on human judgment and its application to clinical practice. Professional Psychology. Research and Practice; 17: 420–30.
Fine, C (2006) A Mind of its Own. WW Norton & Co.
Fulford, KWM (1999) Analytic philosophy, brain science, and the concept of disorder. In Psychiatric Ethics (3rd edn) (eds Bloch, S, Chodoff, P, Green, SA) 161–92. Oxford University Press.
Gigerenzer, G (2002) Reckoning with Risk. Penguin.
Gigerenzer, G (2007) Gut Feelings. Penguin.
Greenhalgh, T (2006) How to Read a Paper. Blackwell.
Groopman, J (2007) How Doctors Think. Houghton Mifflin.
Hart, SD, Michie, C, Cooke, DJ (2007) Precision of actuarial risk assessment instruments. Evaluating the ‘margins of error’ of group v. individual predictions of violence. British Journal of Psychiatry; 190: s605.
Hillson, D, Murray-Webster, R (2005) Understanding and Managing Risk Attitude. Gower.
Janis, IL (1982) Groupthink. Psychological Studies of Policy Decisions and Fiascoes. Houghton Mifflin Company.
Kahneman, D (2003) A perspective on judgment and choice. Mapping bounded rationality. American Psychologist; 58: 697720.
Miller, MC, Tabakin, R, Schimmel, J (2000) Managing risk when risk is greatest. Harvard Review of Psychiatry; 8: 154–9.
Monahan, J (1984) The prediction of violent behavior. Toward a second generation of theory and policy. American Journal of Psychiatry; 141: 10–5.
Montague, R (2006) Why Choose this Book? Penguin.
Plous, S (1993) The Psychology of Judgment and Decision Making. McGraw-Hill.
Ruscio, J (2007) The clinician as subject. Practitioners are Prone to the same judgment errors as everyone else. In The Great Ideas of Clinical Science (eds Lilienfeld, SO, O'Donohue, WT) 2948. Routledge.
Russell, B (1945) A History of Western Philosophy. Simon and Schuster.
Slovic, P, Monahan, J, MacGregor, DG (2000) Violence risk assessment and risk communication. The effects of using actual cases, providing instruction, and employing probability versus frequency formats. Law and Human Behavior; 24: 271–96.
Tavris, C, Aronson, E (2007) Mistakes Were Made (But Not by Me). Why We Justify Foolish Beliefs, Bad Decisions and Hurtful Acts. Harcourt.
Undrill, G (2007) The risks of risk assessment. Advances in Psychiatric Treatment; 13: 291–7.
Watson, C (2003) Risk Management Workshop. Spectrum.
Webster, CD, Douglas, KS, Eaves, D et al (1997) The HCR–20. Assessing Risk for Violence (version 2). Simon Fraser University.
Webster, CD, Hucker, SJ (2007) Violence Risk. Assessment and Management. Wiley.
Weinstock, R, Gold, LH (2004) Ethics in forensic psychiatry. In The American Psychiatric Publishing Textbook of Forensic Psychiatry (eds Simon, RI, Gold, LH) 91116. American Psychiatric Publishing.
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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
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How to make good-enough risk decisions

  • Andrew Carroll
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