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Difficulty: EasyHuman Factors and Cognitive Biases

A 70-year-old man is recovering in the surgical ward on post-operative day 2 following a total knee arthroplasty. The cross-covering night physician is called by the nursing staff because the patient has developed sudden-onset tachycardia and tachypnea. The electronic sign-out note from the day team states, 'Patient is highly anxious about pain; expect tachycardia and treat with PRN opioids.' The night physician reads this note and immediately attributes the new vital sign abnormalities solely to pain-related anxiety. The physician administers a dose of morphine without conducting further evaluation, failing to consider other critical postoperative complications such as a pulmonary embolism. By fixating on the first piece of information provided (the day team's label) to guide the diagnostic approach, which of the following cognitive biases is the night physician primarily demonstrating?

  1. Anchoring biasAnswer
  2. B
    Availability heuristic
  3. C
    Confirmation bias
  4. D
    Framing effect
  5. E
    Ascertainment bias

Answer

Anchoring bias
The physician demonstrates anchoring bias by fixating on the day team's initial sign-out note (the anchor) stating that the patient's tachycardia is expected due to anxiety. This initial piece of information prevents the physician from adequately considering and working up other potentially fatal causes of postoperative tachycardia and tachypnea, such as a pulmonary embolism.

Step-by-Step Solution

1
Analyze the diagnostic error described in the vignette.
The night physician relied entirely on the day team's initial sign-out note characterizing the patient as 'anxious' and failed to perform an independent evaluation for the new tachycardia and tachypnea.
Identifying the specific nature of the error is the first step to classifying the human factors or cognitive bias involved.
2
Match the observed error to the correct cognitive bias definition.
Relying heavily on an initial piece of information to make subsequent judgments matches the definition of anchoring bias.
Anchoring bias specifically describes the phenomenon where initial data points overly influence the final decision, preventing necessary clinical adjustments.

Key Concept

Anchoring bias occurs when a clinician relies too heavily on an initial piece of information (the 'anchor') when making clinical decisions, often failing to adjust their thinking when new information or changes in patient status become available.
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Topics

Human Factors and Cognitive Biases

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