This book introduces a practiceoriented account of how heuristics and cognitive biases shape clinical reasoning and surgical decisionmaking under uncertainty. Building on behavioral economics and dualprocess theory, the authors translate foundational constructssuch as availability, anchoring, confirmation, overconfidence, loss aversion, framing, and survivorship biasinto concrete implications for diagnosis, operative judgment, and multidisciplinary discussions. Drawing on historically grounded clinical narratives, the chapters connect abstract mechanisms to everyday choices in surgery and perioperative care, foregrounding consequences for patient safety and outcomes.
The volume emphasizes awareness, metacognition, and deliberate choice architecture in the operating room and clinic, culminating in general and contextspecific checklists for bias mitigation. While not a comprehensive taxonomy, the book provides a structured entry point for surgeons and trainees seeking to improve decision quality, reduce diagnostic error, and design safer systems.
The original manuscript of this book was written in Spanish and translated into English with the help of artificial intelligence. A subsequent human revision was done primarily in terms of content.
Chapter 1 Introduction.
Chapter 2 Cognitive biases: history and
definition.
Chapter 3 Impact of Cognitive Biases on Clinical Practice.-
Chapter 4 Hindsight Bias. The Death of James Garfield.
Chapter 5 Attention
Bias. Prefrontal Lobotomy and Mental Illness.
Chapter 6 Availability Bias.
The Angelina Jolie effect.
Chapter 7 Negativity bias. Germany and
laparoscopic surgery.
Chapter 8 Illusory correlation: Angina and ligation of
the internal mammary artery.
Chapter 9 Confirmation bias. Arthroscopy in the
treatment of knee osteoarthritis.
Chapter 10 The Law of Triviality. The
Keystone Project.
Chapter 11 Anchoring Bias. The Dysphonia of Kaiser
Frederick III.
Chapter 12 Loss Aversion Bias. Subspecialization in Vascular
Surgery.
Chapter 13 The Halo Effect. The Shah of Irans Cancer.
Chapter 14
Overconfidence Bias. Benjamin Rush and the Yellow Fever Epidemic of 1793.-
Chapter 15 Omission bias. Laparotomy in abdominal trauma.
Chapter 16
Bandwagon Effect. The Rise and Fall of the Adjustable Gastric Band.
Chapter
17 Reactive Devaluation. Ignaz Semmelweis and Handwashing.
Chapter 18
Authority Bias. The Queens Anesthesia.
Chapter 19 Outcome Bias. The Shead
vs Hooley Case.
Chapter 20 Misinformation effect. Peptic ulcer disease and
gastric cooling.
Chapter 21 The Framing Effect: Bernard Fisher and the New
Paradigm of Mastectomy.
Chapter 22 Survivorship Bias. Battey and Normal
Ovariotomy.
Chapter 23 Illusion of Control. The Fastest Knife in the West
End.
Álvaro Sanabria, MD, MSc, PhD is Full Professor of Surgery at the University of Antioquia, Colombia, and a head and neck surgeon at San Vicente Fundación Hospital and affiliated centers in Colombia. Trained in general surgery (University of Antioquia) and head and neck surgery (A.C. Camargo Hospital, Brazil), he holds masters degrees in clinical epidemiology, health economics, and behavioral studies, and a PhD in oncology. His research spans head and neck oncology, evidence synthesis, and surgical decisionmaking.
Carlos Esteban Betancourt Agüero, MD is a head and neck surgeon at CEXCA (Medellín), Colombia, and faculty in the Department of Surgery, University of Antioquia, Colombia. He completed medical and general surgery training at Universidad Centroccidental Lisandro Alvarado (Barquisimeto), Venezuela, and subspecialty training in head and neck surgery at Hospital das Clínicas, University of São Paulo, Brazil. His clinical work focuses on oncologic surgery of the head and neck and reconstructive procedures.
