1. Introduction
Medical professionals face uncertainty and risks in their work on an everyday basis. Decision-making under the circumstances of limited time and a lack of necessary information is always risky in a subjective way. In medicine, it can also lead to the risk of harming the patient. Several recent studies have suggested that while there is a notion that uncertainty and tolerance for uncertainty play a crucial role in medical decision-making, a comprehensive approach towards understanding and assessing uncertainty in healthcare has yet to be framed [
1,
2].
Many aspects of medical decision-making, as well as medical risk assessment, have a rich history of psychological research, mostly within cognitive and organizational psychology frameworks. A few studies have addressed doctors’ susceptibility towards the “framing-effect” (in terms of Kahneman’s and Tversky’s “prospect theory”) [
3,
4], as well as other cognitive biases and heuristics that are usually seen as detrimental but sometimes are seen as beneficial for actual decision-making [
5]. Clinical decisions have often been found to be based on induction, as opposed to the more rational hypothetico-deductive methods [
6], with medical professionals relying more on their experience-based judgments than risk assessment scales that are designed to make those decisions more objective [
7,
8]. Doctors’, nurses’ and medical students’ personality traits that are related to decision-making and risk-taking have also been the subject of psychological research [
9,
10,
11,
12], and it has been shown that surgeons, in addition to being more intolerant to uncertainty [
9], are more prone to risk-taking in a gambling task, based on the game theory [
11], which indicates a possible difference between self-perception of personality and actual behavior. Lawton et al. argued that doctors’ tolerance for uncertainty, as well as their professional experience, can be beneficial for their patients’ safety [
13]. Motivation has also been shown to be related to the choice preferences in medical risk-related verbal tasks [
14]. However, attitudes towards uncertainty and risk-readiness (as the ability to decide under uncertainty) should be considered as the most probable personality-based regulators of the decision-making.
We suggest that a productive avenue to overcome and bridge the existing gaps and discrepancies in the field’s understanding of medical decision-making under uncertainty and risk lies within building a comprehensive approach that can reconcile different research paradigms and emphasize the role of the thinking subject’s intellectual activity. Such an approach is possible within the concept of the unified functioning of a person’s intellectual and personal potential and the dynamic multi-level regulation of human activity under uncertainty [
15,
16]. This approach includes identifying the relationships between medical workers’ personality traits and the specifics of their perception of and relation towards their professional risks.
The research of risk perception in psychology has led to the understanding of cognitive representations of risks and as subjective, complex, and mostly conscious [
17,
18]. Heller et al. argued that residents at different levels of hospital training are not only prone to making heuristic-based decisions but also are more likely to use heuristics in medical tasks comparing to non-medical ones [
19]. Thus, medical risks that are perceived by medical professionals should be distinguished and researched separately from the risks that are unrelated to their professional activities.
While the general idea of cognitive representations of risks as the subject’s image of a risky situation, its possible outcomes and alternative decisions emerged from the works of Kahneman and Tversky [
3], and this idea has yet to be integrated into the analysis of a comprehensive system of the personality-based regulation of the decision-making process [
16]. There is also a need to establish which personality traits play a distinct role in the decision-making regulation and which are more distant from decision processes under uncertainty. Personality traits can also be either relatively stable, like the Big Five personality traits, or show dynamic properties concerning uncertainty, like tolerance or intolerance for ambiguity, risk-readiness, or uncertainty coping mechanisms.
However, the lack of scales assessing the perception of medical risks does not allow us to straightforwardly set the task of identifying the relationship between personality and cognitive representations of risk. To fill this gap, we propose a medical risk assessment procedure based on a scoring system. At the same time, we also identify risky situations that medical doctors themselves consider significant from the point of their professional activities.
The psychometric approach towards risk perception research is based on the assessment of specific types of risk by particular people, e.g., experts or novices in different fields. In those types of studies, lists of various risks and different respondents’ report forms are used. For example, medical risks can be estimated in the numbers of deaths per disease point, in the probabilistic assessment of the event occurrence, etc. [
20]. Gigerenzer discussed, in detail, the risks of the wrong diagnosis due to the specific form of medical data (either probabilistic or natural frequencies-based) [
18]. However, in most of those studies, the participants were provided the list of risks. On the other hand, we wanted to obtain the types of medical risks for future assessment from the doctors themselves via interviews. Thus, the aims of the study were (1) to identify personality specifics of medical doctors via psychodiagnostic methods, (2) to create cognitive representations of medical risks scale with risks being present the same way as in real-life medical practice, and (3) to link those cognitive representations of medical risk with doctors’ personality traits.
The study, therefore, tested the following hypotheses:
Hypotheses 1. Attitudes towards ambiguity, uncertainty coping strategies, risk-readiness and the Big Five personality traits are related to different aspects of the cognitive representation of risks, obtained through the interviews with medical professionals.
Hypotheses 2. Cognitive representations of risk are different for medical practitioners with different professional experiences and of a different gender.
4. Discussion
Based on the results, we accept both our hypotheses. Firstly, relationships between personality traits and the subjective cognitive assessments of various risks (in the professional activity of a doctor) have been established. Secondly, differences in risk assessments by gender and medical experience have been identified. Thus, we believe that the set goals have been achieved and medical risk perception received the required attention due to its subjective importance.
Currently, the psychological understanding of risk is moving away from seeing it as a unitary construct that linked with impulsivity and lack of control [
35]. Indeed, it is the thinking human being who performs risky actions and decisions whose risk perception influences those actions. Risk perception is thus not only based on personality but also modified by experience, which is crystallized in the form of the implicit representation of risky situations, sources and possible outcomes. Concerning professionally significant risks, professional experience might play a crucial role in the shaping of those representations. Thus, it is the professional (in our case, a doctor) who is the carrier of those representations, arguably presented in the form of “tacit knowledge” and thus difficult to realize and verbalize [
22].
Thus, to access that knowledge, or specifically representations of medical risk, we used the interviewing procedure and qualitative analysis of the protocols, resulting in a list of 21 risks that reflect the most frequent categories from the practitioners. Those risks are considered important for the evaluation of risk perception among doctors, at least in Russian-speaking samples. The seven quantitative measurements of CRRs aspects were strongly interconnected in our sample of medical practitioners. In our opinion, this indicates the internal structure of cognitive representations of risk, which also bears similarities with experts’ risk-perception, as seen in previous research [
32].
We theorize that the probability of a negative outcome, which is correlated with all other CRRs aspects and vigilance, might be one of the core aspects of risk evaluation for medical practitioners. The importance of considering negative outcomes might explain its somewhat contradictory positive correlation with predictability (arguably, the more predictable risk should be easier to prevent, but the results oppose that “common-sense” assumption). Pending further research, we assume that with other professionals or laypeople, this CRRs structure will be different. It is also worth noting that the probability of positive outcome bears little correlation with other CRRs aspects and thus might be related to some other risk evaluation strategies or to being more personality-driven.
The findings from our study extend the data available in the literature, highlighting both women’s sensitivity to risk and the idea that risk probability assessment could be professional experience-related (the decrease was especially consistent for the mean probability of risk in the respondent’s practice) [
32].
Moderate correlations of several personality traits with cognitive risk assessments by doctors can be considered in favor of the hypothesis of the unity of functioning of a person’s intellectual and personal potential. However, further research is required in the aspect of the correlation of subjectively perceived and objective risk factors in situations of the professional activity of doctors.
The current study has many limitations, with the sample size being one of the most important. However, the results seem to be meaningful and consistent. For further research, we plan to introduce members of different risky professions into the study as comparison groups.