Cognitive biases encountered by physicians in the emergency room

Abstract

Background Diagnostic errors constitute an important medical safety problem that needs improvement, and their frequency and severity are high in emergency room settings. Previous studies have suggested that diagnostic errors occur in 0.6-12% of first-time patients in the emergency room and that one or more cognitive factors are involved in 96% of these cases. This study aimed to identify the types of cognitive biases experienced by physicians in emergency rooms in Japan. Methods We conducted a questionnaire survey using Nikkei Medical Online (Internet) from January 21 to January 31, 2019. Of the 159,519 physicians registered with Nikkei Medical Online when the survey was administered, those who volunteered their most memorable diagnostic error cases in the emergency room participated in the study. EZR was used for the statistical analyses. Results A total of 387 physicians were included. The most common cognitive biases were overconfidence (22.5%), confirmation (21.2%), availability (12.4%), and anchoring (11.4%). Of the error cases, the top five most common initial diagnoses were upper gastrointestinal disease (22.7%), trauma (14.7%), cardiovascular disease (10.9%), respiratory disease (7.5%), and primary headache (6.5%). The corresponding final diagnoses for these errors were intestinal obstruction or peritonitis (27.3%), overlooked traumas (47.4%), other cardiovascular diseases (66.7%), cardiovascular disease (41.4%), and stroke (80%), respectively. Conclusions A comparison of the initial and final diagnoses of cases with diagnostic errors shows that there were more cases with diagnostic errors caused by overlooking another disease in the same organ or a disease in a closely related organ.

For Medical Directors: Case Report of a Missed Wooden Foreign Body in the Forehead

“…This case provides potential examples of several types of cognitive bias. Infamously, it has been said that, “the most common cause of a misdiagnosis is a prior diagnosis.” This saying describes the phenomenon of anchoring bias, which occurs due to the propensity to rely too heavily on the first piece of information learned (Table 1 ) [ 7 , 8 ]. It is likely that the second treating clinician was subject to anchoring bias, particularly if they relied on the first clinician’s report that the wound was explored for foreign bodies, but none were found.…”

“…Premature closure (Table 1 ), the tendency to arrest further thought about possible explanations or diagnoses likely occurred in this case. Premature closure can be a consequence of anchoring (Table 1 ), which occurs when one overly relies on the first diagnostic impression [ 7 , 8 ]. It is important to avoid the trap of anchoring as it can lead to premature closure.…”

“…It is important to avoid the trap of anchoring as it can lead to premature closure. Additionally, availability bias (Table 1 ) describes the error in attributing a more cognitively straightforward explanation as one that is more representative of reality [ 7 , 8 ]. This error likely occurred as the second treating clinician assumed that the wound infection was due to an infected laceration rather than from retained foreign material.…”

Residents need competence not confidence: A retrospective evaluation of the new competency education program for Korean neurology residents

“…By being aware of the level of residents’ confidence, supervisors are better equipped to make informed guidance and give residents a certain level of autonomy they need to perform in clinical contexts. Similar but a rather differing nuance, Canady and Larzo [ 11 ] claimed that overconfidence made more problematic engagement in clinician’s health behaviors whilst not realizing this deficit [ 12 – 14 ]. By exploring this, our study adds depth to the impact on clinical competency in the context of CBME, where we can highlight the theoretical foundations of CBME and their practical insights to enhance training quality and effectiveness.…”