While a growing body of evidence suggests that healthcare workers in low and middle-income countries often provide poor quality of care, the reasons behind such low performance remain unclear. The literature on medical decision-making suggests that cognitive biases, or failures related to the way healthcare providers think, explain many diagnostic errors. This study investigates whether one cognitive bias, overconfidence, defined as the tendency to overestimate one’s performance relative to others, is associated with the low quality of care provided in Senegal. We link survey data on the overconfidence of health workers to objective measures of the quality of care they provide to standardised patients – enumerators who pose as real patients and record details of the consultation. We find that about a third of providers are overconfident – meaning that they overestimate their own abilities relative to their peers. We then show that overconfident providers are 26% less likely to manage patients correctly and exert less effort in clinical practice. These results suggest that the low levels of quality of care observed in some settings could be partly explained by the cognitive biases of providers, such as overconfidence. Policies that encourage adequate supervision and feedback to healthcare workers might reduce such failures in clinical decision-making.

尽管越来越多的证据表明，中低收入国家的医护人员通常提供的护理质量较差，但这种低绩效的原因尚不清楚。有关医疗决策的文献表明，认知偏见或与医疗保健提供者的思维方式有关的失败可以解释许多诊断错误。这项研究调查了一种认知偏见，过度自信（被定义为高估一个人相对于其他人的表现的趋势）是否与塞内加尔提供的护理质量低下有关。我们将有关医务人员过度自信的调查数据与他们向标准化患者提供的护理质量的客观衡量指标相联系，这些患者是冒充真实患者的调查员，并记录了咨询的细节。我们发现大约三分之一的提供商过分自信-这意味着他们相对于同行而言高估了自己的能力。然后，我们证明，过度自信的提供者正确管理患者并在临床实践中付出较少努力的可能性降低了26％。这些结果表明，在某些情况下观察到的低水平的护理质量可以部分由提供者的认知偏差（例如过度自信）来解释。鼓励对医护人员进行充分监督和反馈的政策可以减少临床决策中的此类失败。这些结果表明，在某些情况下观察到的低水平的护理质量可以部分由提供者的认知偏差（例如过度自信）来解释。鼓励对医护人员进行充分监督和反馈的政策可以减少临床决策中的此类失败。这些结果表明，在某些情况下观察到的低水平的护理质量可以部分由提供者的认知偏差（例如过度自信）来解释。鼓励对医护人员进行充分监督和反馈的政策可以减少临床决策中的此类失败。