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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
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
2/ Intended Learning Outcomes
To recognise common cognitive biases in clinical medicine
To identify strategies to overcome them
#MedTwitter Ready? Let’s go!
To recognise common cognitive biases in clinical medicineTo 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
Are cognitive shortcutsUsed to aid decision-makingAKA heuristicsHelpful time-saversRisk leading to diagnostic errorsDiagnostic error rate in Australian #PrimaryCare is ~15% https://qualitysafety.bmj.com/content/22/Suppl_2/ii21.long
Let’s look at common cognitive biases
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
Overestimating 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.
Seeking & 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.
Excessively 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.
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.
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.
Drawing 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
Learn about cognitive biasesSlow down your thinkingBe systematicHave checklistsAsk for others opinionsCheck 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, 
, 
or 
? http://imreasoning.com/episodes/episode-2-biases/
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
, , or ? 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!
We all make cognitive biases which lead to diagnostic errors in medicineBeing aware of our biases is the 1st step in preventing themThere are ample strategies to reduce cognitive biases & ∴ diagnostic errors. Pick one & try it out this week!
12/ Check out more here:
http://sjrhem.ca/wp-content/uploads/2015/11/CriticaThinking-Listof50-biases.pdf
https://www.intellectualtakeout.org/blog/10-cognitive-biases-affect-your-everyday-decisions
https://www.rcpe.ac.uk/sites/default/files/jrcpe_48_3_osullivan.pdf
https://www1.racgp.org.au/newsgp/professional/reducing-diagnostic-error
http://sjrhem.ca/wp-content/uploads/2015/11/CriticaThinking-Listof50-biases.pdf
https://www.intellectualtakeout.org/blog/10-cognitive-biases-affect-your-everyday-decisions
https://www.rcpe.ac.uk/sites/default/files/jrcpe_48_3_osullivan.pdf
https://www1.racgp.org.au/newsgp/professional/reducing-diagnostic-error
