Fifty Cognitive and Affective biases.

Graber, Mark Mark.Graber at VA.GOV
Sat Sep 7 13:31:23 UTC 2013

I agree - it would be very valuable to somehow improve how we present the biases.  The idea of grouping them is excellent, and many of the heuristics and CDR's (cognitive dispositions to respond, Pat's term) ARE related.

I'd also like to see each one illustrated by a real-world, every day examples outside medicine so learners would recognize that these are all just part of normal cognition.  How about a contest -"Submit Your Best Example".

There is a very little data on prevalence, but in our study it seemed like two were at the top of the list:

 *   Premature closure
 *   Context errors/framing/diagnostic inertia (all related).

From: "co1881 at" <co1881 at>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, "co1881 at" <co1881 at>
Date: Fri, 6 Sep 2013 17:11:35 -0400
Subject: Re: [IMPROVEDX] Fifty Cognitive and Affective biases.

I wonder if Dr. Croskerry would re-publish the list with the ones that are most prevalent/cause the most damage, to the lesser ones, less damaging ones (a hierarchy of damage caused).  If he would make the list of phrases, I would be glad to re-make the list in that order with the explanations included.  I'd like to learn them one at a time, with the most important learned first.  Also, this would make a great list for medical school/residency directors to use and distribute.

Cari Oliver, M.D., J.D.
Cautious Patient Foundation
Oliver Center for Patient Safety and Quality Healthcare, University of Texas Medical Branch

On Thu, Sep 5, 2013 at 5:17 PM, robert bell <rmsbell at> wrote:
Dear all,

I have really appreciated Pat Croskerry's list of 50 biases that physicians can have when making diagnoses. And have sent to others by e-mail to create discussion and thought.

I wondered if this list could be made more useful?  Personally, I would never remember the whole 50 biases on the list.

Could the descriptors more accurately describe the biases to perhaps remember more easily; could similar issues be grouped together; perhaps could there be an attempt to rank the biases in terms of which are more likely to to be present in the average practice situation?

Which brings up the issue of would the types of biases be different for PCPs versus Specialists? And yet again how would you know which are the most important without research? If the biases were ranked would you need different lists for specialists and PCPs or even different lists for different specialities?

And how would you design a study to pick the biases up? Is there bias research in other areas that could perhaps be extrapolated the the medical diagnostic arena?  e.g. Airline industry?

And finally, would the list be more useful if there were 5 to 10 main biases?

Rob Bell, M.D., Ph.C.

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