A hospital's quality improvement committee is reviewing a series of diagnostic errors to identify underlying human factors and cognitive biases. The committee aims to develop targeted educational interventions to improve patient safety. Match each clinical scenario describing a diagnostic error to the specific cognitive bias that best explains the physician's reasoning flaw.
- A patient with slurred speech and ataxia is assumed to be intoxicated based heavily on the triage nurse's initial note of 'alcohol odor.' The physician does not order a head CT, and a cerebellar stroke is missed.Anchoring bias
- During a winter epidemic of viral gastroenteritis, a resident diagnoses a patient's acute nausea and vomiting as a viral illness. The resident fails to consider acute appendicitis due to recent extensive exposure to viral cases.Availability heuristic
- A clinician diagnoses a patient with iron deficiency anemia secondary to heavy menses after a low hemoglobin level is found. The clinician immediately stops evaluating the patient for other causes, missing a concomitant colon cancer.Premature closure
- A physician suspects a patient has systemic lupus erythematosus and selectively focuses the interview on asking about joint pain and rashes, while actively disregarding the patient's complaints of severe back pain.Confirmation bias
Answer
The correct matches are: relying on the initial triage note represents Anchoring bias; overdiagnosing based on a recent outbreak represents Availability heuristic; stopping the workup after finding one cause of anemia represents Premature closure; and selectively gathering symptoms to fit a suspected diagnosis represents Confirmation bias.
Cognitive biases are systematic errors in thinking that affect clinical decision-making and are a major target in Patient Safety and Quality Improvement. Correctly identifying the specific bias is the first step in root cause analysis for these types of diagnostic errors.
Step-by-Step Solution
Key Concept
Cognitive Biases in Clinical Reasoning