The status of heuristics and cognitive biases as a source of diagnostic errors.

Melissa Jones rnstarsfan at GMAIL.COM
Tue Nov 14 19:56:52 UTC 2017


Form a patient perspective.

I would argue that the effect of *cognitive bias* occurs not only when
looking at the actual diagnosis but also when a provider is communicating
and interacting with a patient. My daughter was affected by diagnostic
error: a *delayed diagnosis*. In this case the correct diagnosis was
actually timely made; however, the clinician failed to communicate it to
her in a way, that as a young adult, she could understand. The *curse of
knowledge* affected his ability to communicate at her level, in that he
assumed that the words and concepts he used were as much common knowledge
to her as to him. In addition, the provider did not recognize the, dare we
say predictable, negative* confirmation bias* strongly affecting her
hearing and processing of the diagnosis. This dramatically life-changing
pronouncement was not within her ability at the time to understand and
internalize what was being said. I put forth that it is the responsibility
of the clinician to ensure that the communication they are providing about
a diagnosis is heard *and understood*, otherwise the communication does not
happen, and in my daughter’s case, she went for 5 years under a false
assumption.

Cognitive bias affects more than the mere ability to identify the correct
diagnosis. Intrinsic to the diagnostic process is communication of that
diagnosis so the patient and provider can develop a plan of care that is
both appropriate and effective.  But the onus is upon the provider who
diagnoses. No patient can truly engage a treatment plan or condition
management unless the patient fully understands that plan and the diagnosis
which underlies it.

On Tue, Nov 7, 2017 at 5:48 AM, Jain, Bimal P.,M.D. <BJAIN at partners.org>
wrote:

> In this attached paper, I point out that heuristics and biases are a
> source of inferential errors only in a setting in which the normatively
> correct method of reasoning is probabilistic.
>
> I argue that the notion of heuristics and biases as a source of diagnostic
> errors may not be relevant in diagnosis  which  is not probabilistic in
> practice as I point out in this paper.
>
> I suggest the main sources of diagnostic errors are lack of knowledge
> and/or experience.
>
> Please review and comment on this paper.
>
> Thanks.
>
>
>
> Bimal
>
>
>
> Bimal P Jain MD
>
> Northshore Medical Center
>
> Lynn MA 01904.
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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