Improving Decision-Making in Homeopathic Clinical Practice

Background: Decision-making in homeopathic practice is a highly complex process. Although guidelines for a successful prescription have been set, homeopathic practitioners consciously and unconsciously make use of heuristics ('rules of thumb' /mental shortcuts) in order to reduce this complexity and reach a remedy decision. Whilst biases affecting the reliability of repertory rubrics are now better understood, biases associated with the actual decision-making process are still under-researched.

Objectives:

• To identify and explain the main biases affecting decision making in homeopathic practice.

• To illustrate the role that decision support systems can play in reducing these biases.

Methods: The literature on heuristics and biases that can affect decision-making was searched. Those deemed relevant for decision-making in homeopathic practice were identified. The role that a clinical decision support system (Vithoulkas Compass) can play in minimizing the identified biases was assessed.

Outcomes: The role and implications of the availability heuristic, the representativeness heuristic, the anchoring heuristic as well as confirmation bias will be explained. Repertory software and decision support systems are important tools for improving the quality of homeopathic decision-making. The most important proposed and illustrated innovations are:

1. Prompts about potential biases during the symptom selection process.

2. Visualization of the prevalence (base rate) of the selected symptoms in the general patient population during the decision process.

3. Prompts during the differential diagnosis not to exclude a particular remedy in the absence of particular keynote symptoms.

4. Delaying the shortlisting of potentially indicated remedies, and to base the shortlist on multiple analytical strategies.

Conclusions: The Vithoulkas Compass online homeopathic platform aims to integrate the latest knowledge on reducing biases in clinical decision-making. Optimal decision-making involves blending the useful aspects of heuristics with a slow thinking process that balances the tendency to ‘jump to the wrong conclusions’ as and when needed.

Keywords: Decision-making, heuristic, bias, Vithoulkas Compass

No conflict of interest has been declared by the author(s).