Allison Hempenstall MD+ Your Authors @Dr_Hempenstall @AustAmFulbright Scholar 2020 @HarvardChanSPH | @TorresCapeHHS Rural Generalist | @ACRRM Registrar Committee Chair | @JCUMedDent Senior Lecturer Dec. 01, 2019 2 min read + Your Authors

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

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 🧐

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

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.

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.

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.

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.

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 😴, 🤧, 😤 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!

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 


You can follow @Dr_Hempenstall.



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