Introducing Dx Biases and too much information ... studies needed?
ezamir at UNIMELB.EDU.AU
Wed Aug 14 03:30:40 UTC 2013
Sorry, not sure it went through, resending.
I believe both of the above are true. Accurate clinical info should be provided to anyone who is required to diagnose, whether it is a radiologist, a pathologist or a colleague clinician asked to provide a second opinion. However, the radiologist/pathologist/clinician providing a second opinion should, in my opinion, keep that referral information to the end of their diagnostic routine. An unbiased, fresh diagnostic process is priceless. If, at the end of an independent assessment (without reading the referral), one reaches a conclusion which is consistent with previous diagnoses, the diagnosis is likely to be correct (the odds of two independent observes making the same error are fairly slim). If there is a discrepancy, one should go back and reassess, with the clinical information in mind. The conclusion may remain the same (e.g. if referrer's diagnosis is incorrect) or change (initial impression of diagnostician/second opinion incorrect).
If, however, one reads the referral prior to independently assessing the patient/Xray/path slide, there is a potent bias introduced into the process. I call it "the bias of the question posed" and I have seen examples where even the most obvious findings are repeatedly missed by multiple doctors due to such questions. If not allowed to independently assess the data first, many competent doctors will be distracted by the referrer question in the same way the participants in the "Invisible gorilla" experiment did (see YouTube if you don't know it). As an ophthalmologist I see patients who come from other ophthalmologists or from optometrists for a second opinion . I make it a point to ignore the referral information until after I have taken an independent history and examined the patient myself. Many pathologists and radiologists follow the same routine. I think the issue is not whether or not clinical info is available, but whether that info is allowed to colour the diagnostic process. Keep it till the end and you will have a truly SECOND opinion, free of assumptions and distractions.
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