Debiasing

David Gordon, M.D. davidc.gordon at DUKE.EDU
Wed May 30 16:05:00 UTC 2018


In the epilogue of his book, "How Doctors Think", Dr. Jerome Groopman advocated three questions for patients to ask their health care providers - particularly when things seem awry:

  *   What else could it be?
  *   Is there anything that doesn't fit?
  *   Is it possible that I have more than one problem?


As a provider, I have found these questions to be incredibly helpful to challenge myself with as well. I think the "How are we making this diagnosis?" offered by Peggy is a great discussion prompt, too.


-David


David Gordon, MD
Associate Professor
Associate Program Director
Undergraduate Education Director
Division of Emergency Medicine
Duke University

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________________________________
From: Peggy Zuckerman <peggyzuckerman at GMAIL.COM>
Sent: Wednesday, May 30, 2018 12:59 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Debiasing

Dear All, As a patient advocate, and all too aware of the difficulties that patients have in assessing their own diagnosis, much less the reasons for that diagnosis, I have long contended that patients need to learn to ask a few simple questions.  Moreover, these questions need to be understood as both socially acceptable and appropriate in any circumstances.  That simple question, "How did you conmake that diagnosis?", followed by, "What else could it be?", would open the dialog between the patient and physician.  Inherent is that exchange is the assumption that there could be a clearly stated rationale for the diagnosis, while also acknowledging that there is always uncertainty in a diagnosis.

Peggy Zuckerman
PS  Had I asked that magic question, "What else could it be?", would my 10 cm renal tumor have been found sooner?  And if I had asked  "How did you make that diagnosis?", would I have been shown the pathology report with 'no frank ulcer'?

Peggy Zuckerman
www.peggyRCC.com<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.peggyRCC.com&d=DwMFaQ&c=imBPVzF25OnBgGmVOlcsiEgHoG1i6YHLR0Sj_gZ4adc&r=CegYpq6G0zi1HicElq09U51u9CUItGpOtQzwpjic3t8&m=yDYT856s0XGW_47AtHXhhQlu4omNyOwBW6V1RLNORsE&s=9z3lkzup2RIf7jtJ-vQ_rRfm00gWUa70gg8X8K9WZk8&e=>

On Tue, May 29, 2018 at 6:03 PM, Mark Graber <Mark.Graber at improvediagnosis.org<mailto:Mark.Graber at improvediagnosis.org>> wrote:



FYI …..Attached is a new systematic review of “debiasing” from both medical and non-medical literature.   Most studies found that various debiasing techniques were successful, for example by ‘considering the opposite’.



Several individuals, myself included, have advocated that using an approach like “What else could this be?” would be useful in combatting diagnostic errors related to premature closure, inappropriate anchoring, framing effects, and other tendencies.  Although the article doesn’t mention this particular debiasing approach, the generally positive findings for debiasing in general seems to be a positive thing.



   Mark



Mark L Graber, MD FACP

President, SIDM

Senior Fellow, RTI International

Professor Emeritus, Stony Brook University, NY

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