Seeing isn’t necessarily believing: Misleading contextual information influences perceptual-cognitive bias in radiologists.

Abstract

A substantial number of medical errors in radiology are attributed to failures of perception or decision making, although it is believed that experience (or expertise) might buffer diagnosticians from some types of perceptual-cognitive bias. We examined how the quality of contextual information influences decision making and how underlying perceptual-cognitive processes change as a function of experience and diagnostic accuracy. Twenty-one radiologists dictated their findings on 16 deidentified musculoskeletal radiographic cases while wearing a mobile-eye tracking system. Patient histories were mismatched on a subset of cases to be miscued relative to the correct diagnosis. Experienced radiologists outperformed less-experienced participants, but no systematic differences in gaze behaviors emerged between groups. Miscued case notes increased perceptual-cognitive bias in both groups, resulting in an approximate 40% decrease in diagnostic accuracy. Most errors were judgment errors, meaning participants visually fixated on the abnormality for longer than a second yet still failed to make the correct diagnosis. Findings suggest a physician's confidence in their diagnosis might be misplaced after spending insufficient time extracting relevant information from key areas of the visual display, or when decisions are based primarily on a priori expectations derived from patient histories. Public Significance StatementThis study demonstrates that the accuracy of case notes/patient histories play an important role in cueing radiologists. In addition, these data highlight the importance of spending sufficient time visually fixating on potential abnormalities to avoid perceptual-cognitive bias during diagnostic decision-making.

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