If you feel as I do, you should hope so. But . . . doctors are people, too, and they are sometimes prone to diagnostic error. That includes not only the new physicians, but the most experienced ones as well.
The Illinois State Medical Society (ISME) has an excellent course on “cognitive biases” which are a common cause of diagnostic mistakes. In fact, diagnostic mistakes are the leading cause of medical litigation in the United States.
There are two kinds of thinking that are employed when making a medical diagnosis: Cognitive and Analytical.
Analytical Thinking is what we all hope our doctors do – carefully look at the symptoms, do the appropriate diagnostic tests, interpret the results without bias, draw conclusions based on the test results and factual observations, and diagnose the problem.
Cognitive Thinking is, in the context of medical diagnosis, reactionary and even unconscious thinking. This is a problem even for the most experienced and best physicians – they have “been there, done that,” and sometimes when they see a patient with symptoms that might be familiar, their experience tempts them to draw conclusions based that experience while failing to do the proper analytical process necessary for an accurate diagnosis based on hard facts and test results. Cognitive thinking comes from experience and from observing cause and effect in other situations. It can effect new situations where the symptoms might be similar – but the causes are different. This is a human weakness and is not an indication of a “bad doc.”
Since physicians are people, they are prone to what are called “cognitive bias.” And there are five different kinds of cognitive biases that might affect a diagnosis and cause the physician to draw a wrong conclusion.
According to the ISME course, these cognitive biases are:
- Fundamental Attribution Error – This occurs when the physician observes the patient’s appearance and behavior during the examination and is tempted to blame the symptoms on that appearance, behavior, or known history of such things as alcoholism, drug abuse, mental disorders, etc.
- Confirmation Bias – This occurs when the physician seeks to order tests to confirm what he/she thinks is the problem rather than keep an open mind that the problem might be something else and order tests to either uncover a problem or eliminate a different cause.
- Anchoring – This is the problem of becoming fixated on what the physician might think is the problem and, therefore, cause him/her to not consider alternatives.
- Search Satisficing – Yes – “satisficing” is a word new to me. It means that the physician thinks that he/she has diagnosed the problem and doesn’t press forward to consider alternatives. This can often occur in emergency rooms where the physicians and staff might be overworked and/or tired.
- Availability Bias – This occurs when a physician might have seen a patient with very similar or nearly identical symptoms in the recent past and jumps to a conclusion that the new patient’s problem is the same.
The “Analysis” skill is a critical skill for us all – and especially for physicians.
Even the best doctors – with years of excellent experience – must be constantly aware of the natural cognitive biases that can enter into the diagnostic process.