Thread by @Dr_Hempenstall, 1/ Cognitive Bias in Clinical MedicineI love teaching #MedStudents about #CognitiveBias & [...]

1/ Cognitive Bias in Clinical Medicine

I love teaching #MedStudents about #CognitiveBias & #DiagnosticErrors & so thought I would create my debut #tweetorial on cognitive biases in clinical medicine

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧑🏻‍⚕️" title="Health worker (light skin tone)" aria-label="Emoji: Health worker (light skin tone)">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👩🏽‍⚕️" title="Woman health worker (medium skin tone)" aria-label="Emoji: Woman health worker (medium skin tone)">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👨🏼‍⚕️" title="Man health worker (medium light skin tone)" aria-label="Emoji: Man health worker (medium light skin tone)">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤔" title="Thinking face" aria-label="Emoji: Thinking face">Now which bias that?!

#MedTwitter

1/ Cognitive Bias in Clinical MedicineI love teaching #MedStudents about #CognitiveBias & #DiagnosticErrors & so thought I would create my debut #tweetorial on cognitive biases in clinical medicine https://abs.twimg.com/emoji/v2/... draggable=

2/ Intended Learning Outcomes

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">To recognise common cognitive biases in clinical medicine

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">To identify strategies to overcome them

#MedTwitter Ready? Let’s go!

3/ Cognitive Biases

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Are cognitive shortcuts

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Used to aid decision-making

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">AKA heuristics

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="White heavy check mark" aria-label="Emoji: White heavy check mark">Helpful time-savers

https://abs.twimg.com/emoji/v2/... draggable="false" alt="❎" title="Negative squared cross mark" aria-label="Emoji: Negative squared cross mark">Risk leading to diagnostic errors

https://abs.twimg.com/emoji/v2/... draggable="false" alt="❎" title="Negative squared cross mark" aria-label="Emoji: Negative squared cross mark">Diagnostic error rate in Australian #PrimaryCare is ~15%

https://qualitysafety.bmj.com/content/22/Suppl_2/ii21.long

Let’s">https://qualitysafety.bmj.com/content/2... look at common cognitive biases

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧐" title="Face with monocle" aria-label="Emoji: Face with monocle">

The incidence of diagnostic error in medicine

A wide variety of research studies suggest that breakdowns in the diagnostic process result in a staggering toll of harm and patient deaths. These include autopsy studies, case reviews, surveys of...

https://qualitysafety.bmj.com/content/22/Suppl_2/ii21.long

4/ Availability Heuristic

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">Overestimating the importance of information that is easiest to recall

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You recently miss a cardiac ischaemic event in a patient, prompting you to subsequently order troponins in all patients with chest pain

4/ Availability Heuristichttps://abs.twimg.com/emoji/v2/... draggable=

Overestimating the importance of information that is easiest to recallhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You recently miss a cardiac ischaemic event in a patient, prompting you to subsequently order troponins in all patients with chest pain" title="4/ Availability Heuristichttps://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">Overestimating the importance of information that is easiest to recallhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You recently miss a cardiac ischaemic event in a patient, prompting you to subsequently order troponins in all patients with chest pain" class="img-responsive" style="max-width:100%;"/>

5/ Confirmation Bias

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">Seeking & prioritising information that confirms your existing beliefs

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You suspect a patient has an infection & justify this diagnosis by their elevated white cells, rather than exploring all possible causes of their elevated white cells.

5/ Confirmation Biashttps://abs.twimg.com/emoji/v2/... draggable=

Seeking & prioritising information that confirms your existing beliefshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You suspect a patient has an infection & justify this diagnosis by their elevated white cells, rather than exploring all possible causes of their elevated white cells." title="5/ Confirmation Biashttps://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">Seeking & prioritising information that confirms your existing beliefshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You suspect a patient has an infection & justify this diagnosis by their elevated white cells, rather than exploring all possible causes of their elevated white cells." class="img-responsive" style="max-width:100%;"/>

6/ Anchoring Effect

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">Excessively focusing on the first piece of information you receive when decision-making

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You think that a patient with abdominal pain must have pancreatitis due to their known alcohol abuse, despite a normal lipase.

6/ Anchoring Effecthttps://abs.twimg.com/emoji/v2/... draggable=

Excessively focusing on the first piece of information you receive when decision-makinghttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You think that a patient with abdominal pain must have pancreatitis due to their known alcohol abuse, despite a normal lipase." title="6/ Anchoring Effecthttps://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">Excessively focusing on the first piece of information you receive when decision-makinghttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You think that a patient with abdominal pain must have pancreatitis due to their known alcohol abuse, despite a normal lipase." class="img-responsive" style="max-width:100%;"/>

7/ Bandwagon effect
AKA diagnostic momentum

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">The tendency for people to believe certain things because others think so

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You are handed over a patient with a ‘likely PE’ & go ahead & order the CTPA without reviewing the case or considering other diagnoses.

7/ Bandwagon effect AKA diagnostic momentumhttps://abs.twimg.com/emoji/v2/... draggable=

The tendency for people to believe certain things because others think so https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You are handed over a patient with a ‘likely PE’ & go ahead & order the CTPA without reviewing the case or considering other diagnoses." title="7/ Bandwagon effect AKA diagnostic momentumhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">The tendency for people to believe certain things because others think so https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: You are handed over a patient with a ‘likely PE’ & go ahead & order the CTPA without reviewing the case or considering other diagnoses." class="img-responsive" style="max-width:100%;"/>

8/ Framing effect

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">Drawing different conclusions from the same information presented differently

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: The nurses ask you to quickly discharge a patient with abdo pain. The patient is framed as a ‘frequent flyer’ requesting narcotics, when they really have appendicitis.

8/ Framing effecthttps://abs.twimg.com/emoji/v2/... draggable=

Drawing different conclusions from the same information presented differentlyhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: The nurses ask you to quickly discharge a patient with abdo pain. The patient is framed as a ‘frequent flyer’ requesting narcotics, when they really have appendicitis." title="8/ Framing effecthttps://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Pushpin" aria-label="Emoji: Pushpin">Drawing different conclusions from the same information presented differentlyhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Example: The nurses ask you to quickly discharge a patient with abdo pain. The patient is framed as a ‘frequent flyer’ requesting narcotics, when they really have appendicitis." class="img-responsive" style="max-width:100%;"/>

9/ How can we ‘debias’ our clinical decision making to reduce diagnostic errors?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧐" title="Face with monocle" aria-label="Emoji: Face with monocle">Learn about cognitive biases

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🐢" title="Turtle" aria-label="Emoji: Turtle">Slow down your thinking

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💡" title="Electric light bulb" aria-label="Emoji: Electric light bulb">Be systematic

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📝" title="Memo" aria-label="Emoji: Memo">Have checklists

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🙋🏻‍♀️" title="Happy woman raising one hand (light skin tone)" aria-label="Emoji: Happy woman raising one hand (light skin tone)">Ask for others opinions

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="White heavy check mark" aria-label="Emoji: White heavy check mark">Check in your emotions

https://abs.twimg.com/emoji/v2/... draggable="false" alt="😴" title="Sleeping face" aria-label="Emoji: Sleeping face">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤬" title="Face with symbols over mouth" aria-label="Emoji: Face with symbols over mouth">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="😰" title="Face with open mouth and cold sweat" aria-label="Emoji: Face with open mouth and cold sweat">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⏱" title="Stopwatch" aria-label="Emoji: Stopwatch">Use a diagnostic ‘time out’

#MedTwitter

10/ @IMreasoning recommend using a ‘cognitive forcing checklist’ to think about your thinking (metacognition):

1 What else could this be?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧐" title="Face with monocle" aria-label="Emoji: Face with monocle">

2 What’s the worst it could be?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤯" title="Exploding head" aria-label="Emoji: Exploding head">

3 What doesn’t fit?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧩" title="Jigsaw" aria-label="Emoji: Jigsaw">

4 Do I need to slow down?

5 Am I

https://abs.twimg.com/emoji/v2/... draggable="false" alt="😴" title="Sleeping face" aria-label="Emoji: Sleeping face">,

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤧" title="Sneezing face" aria-label="Emoji: Sneezing face">,

https://abs.twimg.com/emoji/v2/... draggable="false" alt="😤" title="Face with look of triumph" aria-label="Emoji: Face with look of triumph"> or

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤪" title="Zany face" aria-label="Emoji: Zany face">? http://imreasoning.com/episodes/episode-2-biases/">https://imreasoning.com/episodes/...

Episode 2: Biases - IMreasoning

TweetGood articles for further reading on the topic: Diagnostic Failure: A Cognitive and Affective Approach by Pat Croskerry Cognitive Strategies and Detection of Bias by Pat Croskerry The Importance...

http://imreasoning.com/episodes/episode-2-biases/

11/ Take Home Messages:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="White heavy check mark" aria-label="Emoji: White heavy check mark">We all make cognitive biases which lead to diagnostic errors in medicine

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="White heavy check mark" aria-label="Emoji: White heavy check mark">Being aware of our biases is the 1st step in preventing them

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✅" title="White heavy check mark" aria-label="Emoji: White heavy check mark">There are ample strategies to reduce cognitive biases & ∴ diagnostic errors. Pick one & try it out this week!

11/ Take Home Messages:https://abs.twimg.com/emoji/v2/... draggable=

12/ Check out more here:
http://sjrhem.ca/wp-content/uploads/2015/11/CriticaThinking-Listof50-biases.pdf

https://sjrhem.ca/wp-conten... href=" https://www.intellectualtakeout.org/blog/10-cognitive-biases-affect-your-everyday-decisions

https://www.intellectualtakeout.org/blog/10-c... href=" https://www.rcpe.ac.uk/sites/default/files/jrcpe_48_3_osullivan.pdf

https://www.rcpe.ac.uk/sites/def... href=" https://www1.racgp.org.au/newsgp/professional/reducing-diagnostic-error">https://www1.racgp.org.au/newsgp/pr...

10 Cognitive Biases That Affect Your Everyday Decisions | Intellectual Takeout

http://sjrhem.ca/wp-content/uploads/2015/11/CriticaThinking-Listof50-biases.pdf

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