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

Jain, Bimal P.,M.D. BJAIN at PARTNERS.ORG
Tue Nov 14 20:09:03 UTC 2017


I agree completely that cognitive bias plays a role in communicating a diagnosis.
However the discussion in my paper is limited to the role of heuristics in making a diagnosis. Thanks.
Bimal

From: Melissa Jones [mailto:rnstarsfan at gmail.com]
Sent: Tuesday, November 14, 2017 2:57 PM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at list.improvediagnosis.org>; Jain, Bimal P.,M.D. <BJAIN at PARTNERS.ORG>
Subject: Re: [IMPROVEDX] The status of heuristics and cognitive biases as a source of diagnostic errors.

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<mailto: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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