Medical decision-making under risk and uncertainty: Anesthetists' decision to proceed with surgery

There is a paucity of work examining anesthetists' willingness to proceed as attending anesthetists (hereafter, WTP) in response to different risky medical conditions. Earlier studies offer only a partial and indirect explanation as to why variations in WTP exist. We evaluated whether psychological factors of risk-taking tendencies, attitudes toward uncertainty, sense of regret, and demographic variables, particularly experience and gender, might clarify the disparities in an anesthetist's WTP. Anesthetists from two National Health Service Trusts in England (i.e., hospitals) viewed, in random order, three different realistic scenarios (representing low-, medium-, and high-risk cases) and were asked to indicate how likely they were to agree to proceed as the attending anesthetist. They also answered questions evaluating their risk-taking tendencies, comfort with uncertainty, and tendency to experience regret. Anesthetists varied in their WTP. Importantly, our data revealed that a sense of uncertainty and regret, but not a risk attitude, could help explain these variations. Female anesthetists were less likely to agree to proceed as attending anesthetists regardless of the level of risk or individual differences, but we found no relationship between levels of experience and WTP. Examining anesthetists' WTP in isolation provides an important but only partial picture. Gaining a better understanding of the factors that drive decision-making is vital for improving both training and practice. In particular, given the high proportion of women in anesthesia, the gender difference found in this study has important implications for anesthetic training and practice.