Examkin

Soru

Zorluk: OrtaHuman Factors and Cognitive Biases

A 63-year-old woman is admitted to the medical ward from the emergency department (ED) with a working diagnosis of viral gastroenteritis. During the shift change, the ED physician signs out to the admitting resident, stating, 'She has diffuse abdominal pain, nausea, and non-bloody emesis. There is a huge viral bug going around right now, so it is a classic presentation. She just needs intravenous fluids and antiemetics overnight.' Her initial basic metabolic panel shows a mildly elevated blood urea nitrogen, which is attributed to mild dehydration. When the admitting resident evaluates the patient, he notes her history of type 2 diabetes mellitus and hypertension. The patient mentions that her abdominal pain occasionally radiates to her jaw and left shoulder. The resident documents this as 'musculoskeletal pain secondary to forceful retching' and decides not to order an electrocardiogram or cardiac biomarkers, focusing solely on the abdominal symptoms to support the viral etiology. The patient later suffers a massive myocardial infarction.

Which of the following cognitive biases and diagnostic errors are explicitly demonstrated by the admitting resident's reasoning? (Select all that apply)

  1. Anchoring biasCevap
  2. Confirmation biasCevap
  3. C
    Availability heuristic
  4. D
    Framing effect
  5. Premature closure of the differential diagnosisCevap

Cevap

The resident's reasoning demonstrates anchoring bias, confirmation bias, and premature closure of the differential diagnosis.
The correct answers identify the specific cognitive flaws in the resident's approach. The resident exhibited anchoring bias by fixating on the handoff diagnosis of gastroenteritis. Confirmation bias occurred when the resident actively interpreted a red-flag symptom (jaw and shoulder pain) as benign musculoskeletal pain merely to support the initial viral diagnosis. Finally, premature closure was demonstrated when the resident ended the diagnostic workup without ordering an ECG for a high-risk patient experiencing classic anginal equivalent symptoms.

Adım Adım Çözüm

1
Identify how the resident processed the handoff information.
The resident accepted the ED physician's diagnosis without independent critical thought.
This establishes anchoring bias, where an initial diagnostic label unduly influences subsequent clinical evaluation.
2
Analyze how the resident handled new, contradictory clinical data.
The resident attributed the high-risk symptom of jaw and shoulder pain to forceful retching.
This indicates confirmation bias, as the physician warped new evidence to fit the pre-existing diagnosis while ignoring alternative explanations.
3
Evaluate the completeness of the clinical workup.
No electrocardiogram or cardiac biomarkers were ordered.
This constitutes premature closure, as the diagnostic process was terminated before 'must-not-miss' alternative diagnoses were properly ruled out.

Anahtar Kavram

Diagnostic errors often result from cognitive biases such as anchoring (fixating on initial information), confirmation bias (selectively interpreting evidence to support a preconceived diagnosis), and premature closure (stopping the diagnostic process too early).
Bu soruyu puanla

Konular

Human Factors and Cognitive Biases

Bu konudan daha fazla soru