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 (especially the potentially fatal ones). That concept gets drilled into our head constantly over here. You're right - "pretending it's the worst-case-scenario" is wrong, but seriously considering the worst-case scenario is essential. A CT would have been wrong, but there are other tests (i.e. finding problems with one side of the body but not the other is a dead-giveaway).

I don't want to rag on this doc - this patient was coming from a party, and I don't know if her specific case could easily be distinguished from excessive alcohol use. But it did help drive home the importance to keep my eyes open.