I attended a conference this week and heard Jerome Groopman, MD, author of “How Doctors Think”, speak. He highlighted some concepts that I found to be very enlightening.
The conference topic was reducing diagnostic errors. Dr. Groopman said that lack of knowledge is not usually the cause of misdiagnoses. They are due to errors in thinking. We then proceeded to outline several cognitive errors and recommendations for addressing them.
Cognitive errors include “anchoring”. This is the tendency to latch on to the first data that supports our working diagnosis. We give too much weight to the importance of that bit of information rather than keeping our minds open to other possibilities.
Another concept is “availability”. This is the tendency to allow recent experience that is similar, to create a bias leading us to believe that the two situations are the same. In other words, we think that we have seen this situation before and we jump to the conclusion that the same response is appropriate for the new experience. It may not be appropriate for the new experience leading to a diagnostic error.
Most people are familiar with the concept of confirmation bias. This occurs when we focus on or select data that confirms our initial diagnosis. This bias often causes us to down-play the importance of data that does not confirm our “anchored” impression.
Our feelings and emotions can also play a role in clouding our ability to reach a correct diagnosis. We receive satisfaction when we reach a conclusion that we believe is correct. This can reduce our willingness to look for other possible alternatives. We form stereotypes that prompt us to overlook important information because we think that this person looks like the other “drug seekers”, for example.
To guard against these cognitive errors, Dr. Groopman recommended asking the following questions:
What else could it be?
Could two things be going on at the same time?
Is there any data that does not fit with our initial thoughts about a diagnosis?
We should also set up systems of communication that prompt others to ask questions or raise other possibilities. Set up a script so that the correct questions are asked. Encourage people to think independently and not just confirm the incorrect diagnosis.
Let’s create environments that facilitate open discussion, welcome questions and encourage everyone who has information, to speak up.