Fun fact: in medical school, we had a mini-lesson on common cognitive errors in medicine

ancientcampus

Yesterday in medical school, we had a lecture on common mistakes doctors make. I saw this slide:

Attribution Errors

Confirmation Bias

Commission Bias

Omission Bias

Anchoring

-which made me smile, and thought I'd share. I'm interested in Emergency Medicine, and I realize that some of these are a real problem in that field. I.e. I know one doctor who had a typical Friday night - most of the patients are super drunk. One 30-year-old girl comes in disoriented, off-balance, with slurred speech. They suggest she sleep it off. Unfortunately, this particular patient was having a stroke, and died. So yeah. Avoiding biases.

(If anyone cares - Anchoring is basically the bias towards your first guess, or in this case, diagnosis, aka "we change our minds less likely than we think". Commission and Omission bias are, in this case, the tendency to act (in order to help) when you perhaps shouldn't, and the the tendency to inaction (to avoid harm) when you should act, respectively.)

Yesterday in medical school, we had a lecture on common mistakes doctors make. I saw this slide:

Attribution Errors

Confirmation Bias

Commission Bias

Omission Bias

Anchoring

Your example (friday night 30-year-old stroke victim) does not show a bias, but merely that going with the most likely hypothesis is no guarantee to get the correct result every time (as opposed to most of the time). You can be wrong without having reasoned wrongly.

If you're treating with the maxim of "pretend it's the worst possible eventuality, no matter how unlikely", you'll cause a lot more harm than good. When does it stop? "CT (nevermind the radiation exposure) doesn't show a stroke? Well, could still be one anyways, let's treat for the worst case scenario." Nevermind that a priori a stroke is already supremely unlikely in your example scenario, and that stroke treatments are dangerous in their own right.

There are so many obscure diseases that share symptoms with e.g. a common cold ...

True, the example I gave didn't specifically illustrate any particular bias. However, I think there was a little bit of anchoring and confirmation bias involved. He expected to see an alcohol-OD patient. He saw a lot of symptoms that fit the diagnosis. I don't know her specific case, if there were symptoms he missed or disregarded, but it's probably a safe assumption.

The thing is - yes, alcoholism is the most likely hypothesis. However, anyone could say that alcoholism was the most likely hypothesis; it's the doctor's job to also consider the unlikely ones... (read more)

25TrE14y

But looking for one piece of evidence that could have disproved the initial hypothesis would have prevented this, and not be such a time-waster. Just perform a simple test that's checking whether the patient is really drunk, for example: "Does their breath smell like alcohol?" Just a quick glance into the dark would've been enough here.

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Fun fact: in medical school, we had a mini-lesson on common cognitive errors in medicine

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Fun fact: in medical school, we had a mini-lesson on common cognitive errors in medicine

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