Expert clinicians utilize targeted debiasing strategies almost instinctively

@rabihmgeha at #SGIM23 employing “What can’t I explain?” for a pt w “CHF exacerbation” hypoxic to 70% on RA, improved to 92% on 3L

Photo from my recent Cognitive M&M courtesy of @UABMedPeds @uabimres He emphasized: the crux of the case probably lies in this one point.
That you went from “may need to intubate” to “looks great” with only 3Lnc?

Doesn’t add up…

Consider an alternative etiology for his hypoxemia — notably, w such profound response to minimal O2, hypercarbia

Formulating and appraising your PR (problem representation) is critical to the diagnostic process, and intrinsically welcomes cognitive bias

Work this case with me #MedTwitter

ED calls for admission: “40yo M w pneumonia”

*fist pump* sweet, easy admission

1/ “Fever, cough, dyspnea x2d. WBC 20, triggered sepsis. Got cx, fluids, abx. CXR RLL infiltrate. Needs admission for sepsis 2/2 CAP”

With that PR, slam dunk pneumonia.

100% match for my CAP illness script, don’t even need my dyspnea schema (courtesy of @DxRxEdu @CPSolvers)