Countering cognitive biases in minimising low value care

Ian A Scott, Jason Soon, Adam G Elshaug and Robyn Lindner
Med J Aust 2017; 206 (9): . || doi: 10.5694/mja16.00999
Published online: 15 May 2017



  • Cognitive biases in decision making may make it difficult for clinicians to reconcile evidence of overuse with highly ingrained prior beliefs and intuition.
  • Such biases can predispose clinicians towards low value care and may limit the impact of recently launched campaigns aimed at reducing such care.
  • Commonly encountered biases comprise commission bias, illusion of control, impact bias, availability bias, ambiguity bias, extrapolation bias, endowment effects, sunken cost bias and groupthink.
  • Various strategies may be used to counter such biases, including cognitive huddles, narratives of patient harm, value considerations in clinical assessments, defining acceptable levels of risk of adverse outcomes, substitution, reflective practice and role modelling, normalisation of deviance, nudge techniques and shared decision making.
  • These debiasing strategies have considerable face validity and, for some, effectiveness in reducing low value care has been shown in randomised trials.


  • 1 Princess Alexandra Hospital, Brisbane, QLD
  • 2 University of Queensland, Brisbane, QLD
  • 3 Royal Australasian College of Physicians, Sydney, NSW
  • 4 Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
  • 5 NPS MedicineWise, Sydney, NSW


Competing interests:

Ian Scott is a member of the Australian Government Department of Health’s Medicare Benefits Schedule Review Taskforce and is a clinical lead for the Royal Australasian College of Physicians (RACP) EVOLVE program. Jason Soon is Senior Policy Officer at the RACP and is the Lead Policy Officer for the EVOLVE program. Adam Elshaug receives salary support as the HCF Research Foundation Professorial Research Fellow, and holds research grants from the Commonwealth Fund and the National Health and Medical Research Council (no. 1109626 and 1104136). He receives consulting fees from Cancer Australia, the Capital Markets Cooperative Research Centre’s Health Quality Program, NPS MedicineWise (as facilitator of Choosing Wisely Australia), the RACP (as facilitator of the EVOLVE program) and the Australian Commission on Safety and Quality in Health Care, and is a member of the Australian Government Department of Health’s Medicare Benefits Schedule Review Taskforce. Robyn Lindner is the Client Relations Manager at NPS MedicineWise and is involved in the implementation of Choosing Wisely Australia.

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