Understanding bias could help healthcare providers reduce medical mistakes made during the diagnostic process.

Diagnostic errors account for a large portion of medical errors.  The evaluative process is used by physicians and Advanced Practice Providers across the medical industry.  The ability—through skill, education, and training—to provide an accurate diagnosis is a fundamental reason people seek medical advice.  Studies suggest between 40,000 to 80,000 patients die each year in American hospitals due to diagnostic error.

Both a common and complex medical mistake, some diagnostic error finds its roots in the perception of the clinician responsible for forming the diagnosis. Research published in the AMA Journal of Ethics points to types of bias that affect how a physician gathers evidence and information, takes action based on the information, and then evaluates that decision.

Four types of bias include:

  • Confirmation bias:  A patient seen by a physician suffers chest pain among other symptoms.  The ED provider diagnose and treats the patient for myocardial infarction, a heart attack.  The patient undergoes an emergency course of treatment to counter the cardiac event.  The patient’s condition worsens, the patient dies and it is then learned he suffered from an aortic dissection. Confirmation bias occurs when a physician “sees what they want to see,” based on their experience rather than the additional symptoms suffered by the patient.
  • Outcome bias: Oftentimes clinicians order tests that result in a good outcome, but for which there was not really a relevant reason.  In this instance, physicians may believe the outcome was attributable to their “good call,” rather than a lucky or even unadvisable guess.
  • Anchoring bias: When a diagnosis is made, a healthcare provider may ignore contrary evidence, and stick with their first impression.  This is another bias that involves priority placed on symptoms which support the initial diagnosis, without objectivity needed to make a correct diagnosis.
  • Affect heuristic:  Diagnostic decisions are based on many factors.  When a diagnosis is based on, or influenced by how a clinician feels, there is significant room for error.  A patient of whom a physician has a negative—or positive—impression based on the past experiences of the physician can receive a diagnosis that is not related to their actual symptoms and physiological status—but on the emotional response of the doctor.

The thought processes of physicians are extremely important to a correct diagnosis.  Providers who rarely reflect on their own diagnostic processes are less likely to identify their own biased perspectives—putting their patients in harms way.

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