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Zorluk: KolayHuman Factors and Cognitive Biases

A 55-year-old woman presents to the emergency department with a 2-hour history of retrosternal chest pain. The triage nurse documents 'likely severe acid reflux' in the electronic triage note because the patient recently ate a large, spicy meal. The attending physician reads this note prior to evaluating the patient. During the clinical encounter, the physician focuses the history exclusively on gastrointestinal symptoms and performs a brief abdominal exam. The physician confidently diagnoses gastroesophageal reflux disease without considering acute coronary syndrome or ordering an electrocardiogram and cardiac biomarkers. The patient is discharged with a prescription for a proton pump inhibitor but returns the next day with a massive myocardial infarction. Which of the following cognitive biases best characterize the physician's decision-making errors in this scenario? (Select all that apply)

  1. Anchoring biasCevap
  2. Premature closureCevap
  3. C
    Availability heuristic
  4. D
    Affect heuristic
  5. E
    Sunk cost fallacy

Cevap

The correct cognitive biases demonstrated are anchoring bias and premature closure.
The scenario clearly illustrates two distinct cognitive errors. First, the physician demonstrates anchoring bias by fixating on the initial triage note ('likely severe acid reflux') and failing to adjust this impression during the encounter. Second, the physician demonstrates premature closure by ending the diagnostic process and finalizing a benign diagnosis without actively considering or ruling out 'must-not-miss' conditions like acute coronary syndrome.

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1
Analyze the physician's initial approach to the patient.
The physician adopted the triage nurse's diagnostic suggestion of acid reflux before even evaluating the patient.
Identifying the influence of initial information points toward anchoring bias.
2
Evaluate the completeness of the diagnostic workup.
The physician diagnosed gastroesophageal reflux disease and discharged the patient without ordering standard tests to rule out acute coronary syndrome in a patient with chest pain.
Stopping the diagnostic process before considering and ruling out other life-threatening conditions defines premature closure.

Anahtar Kavram

Cognitive biases such as anchoring bias and premature closure are major human factor vulnerabilities that lead to diagnostic errors and patient harm.
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Konular

Human Factors and Cognitive Biases

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