Table 1.

Factors that may impede medicine’s acceptance of the integral role played by JDM biases in medical decision-making

Factor	Comment
Lack of cognitive science training in medicine	Medicine has a history of insularity and going its own way. Cognitive science may suffer from the not-invented-here (NIH) syndrome
Difficulty in incorporating cognitive science into the curriculum	Medical undergraduate curricula are usually full and there is little room for additional material, so traditional content and the status quo prevails. With constant updates of existing content, it is difficult to introduce new material, especially any that does not appear to have immediate clinical relevance
Lack of appropriately trained personnel to teach about cognition	Appropriate instructors in cognitive science could be recruited from other disciplines, once Medicine recognises this need; later, it can develop its own
Invisibility of cognitive processes	Historically, Medicine has emphasised the tangible and visible. Sophisticated imaging allows clinicians to see the problem even down to a cellular level. However, the imaging of cognitive processes is presently a formidable challenge
Discomfort and even antipathy against the term ‘Heuristics and Biases’	‘Heuristics’ is an uncommon term in medicine and not usually used in clinical decision-making. Further, the use of the word ‘bias’ tends to get seen negatively rather than as an objective way of looking at cognitive behaviour. Most clinicians would not like to hear their decisions described as biased. Describing the problem as a JDM bias may displace the blame somewhat and make it less personal
Status quo and extra work	Many physicians are busy and typically overworked. Learning about cognitive science is extra work added to already busy schedules. Cognitive miserliness is likely with a tendency to preserve the status quo
Denial, discounting and distancing	Physicians hold dear their ability to accurately diagnose illness. Confronted with the failure rates reported they may engage defensively in alternate explanations rather than accept an understanding of cognitive science as a necessity
Cognitive science is a novel concept to many	While clinicians readily accept the need for regular updating of their existing knowledge, they may resist learning about a new approach not traditionally covered in the medical curriculum
Bias is difficult to correct, so why invest time in it?	CBM is challenging and may require significant effort, but recent work suggests that some CBM strategies may be effective
Complexity of the diagnostic process	Overall, the medical diagnostic process is both complicated and complex. With a limited understanding of the process itself, many clinicians would be reluctant to add a new approach to their current understanding of it