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

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.

I would recommend the even simpler test of asking the patient how much they've been drinking.

I wouldn't be surprised if the reason the patient made it through triage to get the attention of the doctor is that the nurse had ruled out drunkenness.

3Kawoomba14y

A quick glance, in this case? Maybe. Someone coming in with a head concussion? On average (at a nearby university clinic) a hundred cranial CTs to find one abnormality. Many of those turning out harmless (similar to e.g. enlarged prostates, or calcified breast ducts). The biopsies to confirm, however, will cause a percentage of severe damage, which is why many screening tests are now postponed (e.g. recent media storm over breast screening recommendations being reduced, similar with more lax PSA watch and wait approaches). The number needed to treat (NNT) to save one life can sometimes be measured in dozens of unnecessary incontinence cases, later "unrelated" cancer (often eluding the statistics), thromboses after biopsies, etcetera. Even when non-invasive tests are amenable to the situation at hand, you'd be surprised how many quick glances it takes to further rule out various unlikely hypotheses, or how long such quick glances can take in actuality. A short neural exam - and the mandatory documentation to go with it? Say 10 minutes, per patient. Rule out some additional unlikely hypotheses? Explain that to the gurneys filling the waiting room hallways. ER's are often crowded as is, additional waiting time will also kill patients. Efficient resource utilisation, using the resouces at hand, is crucial. There's a famous med school saying that goes "when you hear hooves, think horses, not zebras". Much of the deviation from that rule is based on defensive medicine, which aims at avoiding costly lawsuits, a very poor surrogate marker for saving lives. Pick your poison, but beware that there'll be "sob stories" either way, that could be avoided with other approaches. Confirmatory "glances" only make sense to reach a certain certainty threshold in the main hypothesis. In the case of a girl coming in from a party on a friday night with slurred speech, I'd expect there to be thousands of (documented) "smell tests" - or breath alcohol measurements, to hold up in court,

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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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