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

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 Now which bias that?! #MedTwitter

2/ Intended Learning Outcomes

To recognise common cognitive biases in clinical medicine

To identify strategies to overcome them

#MedTwitter Ready? Let’s go!

3/ Cognitive Biases

Are cognitive shortcuts

Used to aid decision-making

AKA heuristics

Helpful time-savers

Risk leading to diagnostic errors

Diagnostic error rate in Australian #PrimaryCare is ~15%

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

Let’s look at common cognitive biases

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

Overestimating the importance of information that is easiest to recall

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 HeuristicOverestimating the importance of information that is easiest to recallExample: You recently miss a cardiac ischaemic event in a patient, prompting you to subsequently order troponins in all patients with chest pain

5/ Confirmation Bias

Seeking & prioritising information that confirms your existing beliefs

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 BiasSeeking & prioritising information that confirms your existing beliefsExample: 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.

6/ Anchoring Effect

Excessively focusing on the first piece of information you receive when decision-making

Example: You think that a patient with abdominal pain must have pancreatitis due to their known alcohol abuse, despite a normal lipase.

6/ Anchoring EffectExcessively focusing on the first piece of information you receive when decision-makingExample: You think that a patient with abdominal pain must have pancreatitis due to their known alcohol abuse, despite a normal lipase.

7/ Bandwagon effect
AKA diagnostic momentum

The tendency for people to believe certain things because others think so

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 momentumThe tendency for people to believe certain things because others think so Example: You are handed over a patient with a ‘likely PE’ & go ahead & order the CTPA without reviewing the case or considering other diagnoses.

8/ Framing effect

Drawing different conclusions from the same information presented differently

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 effectDrawing different conclusions from the same information presented differentlyExample: 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.

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

Learn about cognitive biases

Slow down your thinking

Be systematic

Have checklists

Ask for others opinions

Check in your emotions

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?

2 What’s the worst it could be?

3 What doesn’t fit?

4 Do I need to slow down?

5 Am I

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

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:

We all make cognitive biases which lead to diagnostic errors in medicine

Being aware of our biases is the 1st step in preventing them

There are ample strategies to reduce cognitive biases & ∴ diagnostic errors. Pick one & try it out this week!