1/ Cognitive Bias in Clinical Medicine
I love teaching #MedStudents about #CognitiveBias & #DiagnosticErrors & so thought I would create my debut #tweetorial on cognitive biases in clinical medicine 🧑🏻⚕️👩🏽⚕️👨🏼⚕️
🤔Now which bias that?!
#MedTwitter
I love teaching #MedStudents about #CognitiveBias & #DiagnosticErrors & so thought I would create my debut #tweetorial on cognitive biases in clinical medicine 🧑🏻⚕️👩🏽⚕️👨🏼⚕️
🤔Now which bias that?!
#MedTwitter
2/ Intended Learning Outcomes
💡To recognise common cognitive biases in clinical medicine
💡To identify strategies to overcome them
#MedTwitter Ready? Let’s go!
💡To recognise common cognitive biases in clinical medicine
💡To identify strategies to overcome them
#MedTwitter Ready? Let’s go!
3/ Cognitive Biases
💡Are cognitive shortcuts
💡Used to aid decision-making
💡AKA heuristics
✅Helpful time-savers
❎Risk leading to diagnostic errors
❎Diagnostic error rate in Australian #PrimaryCare is ~15%
qualitysafety.bmj.com/content/22/Sup…
Let’s look at common cognitive biases 🧐
💡Are cognitive shortcuts
💡Used to aid decision-making
💡AKA heuristics
✅Helpful time-savers
❎Risk leading to diagnostic errors
❎Diagnostic error rate in Australian #PrimaryCare is ~15%
qualitysafety.bmj.com/content/22/Sup…
Let’s look at common cognitive biases 🧐
4/ Availability Heuristic
📌Overestimating the importance of information that is easiest to recall
💡Example: You recently miss a cardiac ischaemic event in a patient, prompting you to subsequently order troponins in all patients with chest pain
📌Overestimating the importance of information that is easiest to recall
💡Example: You recently miss a cardiac ischaemic event in a patient, prompting you to subsequently order troponins in all patients with chest pain
5/ Confirmation Bias
📌Seeking & prioritising information that confirms your existing beliefs
💡Example: You suspect a patient has an infection & justify this diagnosis by their elevated white cells, rather than exploring all possible causes of their elevated white cells.
📌Seeking & prioritising information that confirms your existing beliefs
💡Example: You suspect a patient has an infection & justify this diagnosis by their elevated white cells, rather than exploring all possible causes of their elevated white cells.
6/ Anchoring Effect
📌Excessively focusing on the first piece of information you receive when decision-making
💡Example: You think that a patient with abdominal pain must have pancreatitis due to their known alcohol abuse, despite a normal lipase.
📌Excessively focusing on the first piece of information you receive when decision-making
💡Example: You think that a patient with abdominal pain must have pancreatitis due to their known alcohol abuse, despite a normal lipase.
7/ Bandwagon effect
AKA diagnostic momentum
📌The tendency for people to believe certain things because others think so
💡Example: You are handed over a patient with a ‘likely PE’ & go ahead & order the CTPA without reviewing the case or considering other diagnoses.
AKA diagnostic momentum
📌The tendency for people to believe certain things because others think so
💡Example: You are handed over a patient with a ‘likely PE’ & go ahead & order the CTPA without reviewing the case or considering other diagnoses.
8/ Framing effect
📌Drawing different conclusions from the same information presented differently
💡Example: The nurses ask you to quickly discharge a patient with abdo pain. The patient is framed as a ‘frequent flyer’ requesting narcotics, when they really have appendicitis.
📌Drawing different conclusions from the same information presented differently
💡Example: The nurses ask you to quickly discharge a patient with abdo pain. The patient is framed as a ‘frequent flyer’ requesting narcotics, when they really have appendicitis.
9/ How can we ‘debias’ our clinical decision making to reduce diagnostic errors?
🧐Learn about cognitive biases
🐢Slow down your thinking
💡Be systematic
📝Have checklists
🙋🏻♀️Ask for others opinions
✅Check in your emotions 😴🤬😰
⏱Use a diagnostic ‘time out’
#MedTwitter
🧐Learn about cognitive biases
🐢Slow down your thinking
💡Be systematic
📝Have checklists
🙋🏻♀️Ask for others opinions
✅Check in your emotions 😴🤬😰
⏱Use a diagnostic ‘time out’
#MedTwitter
10/ @IMreasoning recommend using a ‘cognitive forcing checklist’ to think about your thinking (metacognition):
1 What else could this be? 🧐
2 What’s the worst it could be? 🤯
3 What doesn’t fit? 🧩
4 Do I need to slow down?
5 Am I 😴, 🤧, 😤 or 🤪?
imreasoning.com/episodes/episo…
1 What else could this be? 🧐
2 What’s the worst it could be? 🤯
3 What doesn’t fit? 🧩
4 Do I need to slow down?
5 Am I 😴, 🤧, 😤 or 🤪?
imreasoning.com/episodes/episo…
11/ Take Home Messages:
✅We all make cognitive biases which lead to diagnostic errors in medicine
✅Being aware of our biases is the 1st step in preventing them
✅There are ample strategies to reduce cognitive biases & ∴ diagnostic errors. Pick one & try it out this week!
✅We all make cognitive biases which lead to diagnostic errors in medicine
✅Being aware of our biases is the 1st step in preventing them
✅There are ample strategies to reduce cognitive biases & ∴ diagnostic errors. Pick one & try it out this week!
