These specific emotional biases are captured under the overarching affect heuristic58 reflecting
the integral role of emotion in judgment and decision making. Emotional reactions are automatic
and often the very first reaction in a decision making situation.14, 59 Indeed, emotion is an integral
feature of intuitive reasoning, one of the two major systems of information processing that have
been proposed in decision making 60 and where the majority of reasoning errors are believed to
occur. 61 The emotional heuristic may either augment decision making or compromise it
leading to error. As a general rule, ‘hot’ (reflexive, current) affect is associated with incomplete
consideration of information and leads to poor decisions, whereas ‘cold’ (anticipated, regulated)
affect is more beneficial and associated with better calibrated decisions. 62 The dynamic substrate
of at least some of the specific errors described here appears to reside in one or more of the
endogenous or emotionally dysregulating features of physician behaviors that are discussed in the
following sections. Detailed descriptions, as well as the consequences of a variety of cognitive
and emotional biases have been provided, as well as strategies for avoiding them.63, 64 Error
Management Theory has attributed the abundance of these biases to their evolutionary adaptive
value.65
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