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How do doctors classify patients into disease categories? Many psychological theories assume that doctors look up and integrate all evidence, as in exemplar models of categorization, but in reality much of decision making is sequential and frugal. For instance, in routine HIV screening, a physician begins with an ELISA test. If it is negative, testing is stopped and the diagnosis is “not infected.” If it is positive, another ELISA test (preferably from a different manufacturer) will be performed. If this is negative, the diagnosis will be “not infected.” If, however, the result is again positive, a Western blot test will be conducted. If this is negative, the diagnosis will be “not infected,” and if positive, “infected.” This sequential procedure, which may be repeated with another blood sample, does not correspond to a full tree with complete information. It is a “fast-and-frugal tree,” which ignores part of the information. For instance, if the first ELISA test is negative, no other tests will be conducted, even though sometimes an infection is missed with an ELISA. A 36-year-old HIV-infected American construction worker who tested negative for HIV 35 times holds the world record in “misses” (Gigerenzer, 2002). Fast-and-frugal trees are a standard technique for classification, from HIV tests to cancer screening. Yet these heuristics have received too little attention in the psychology of categorization and decision making.
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