5: Physician Bias - Feilmeier

Question 1

well learned sets of associations

Answer 1

stereotype

Question 2

conscious effort to focus on specific info about the individual

Answer 2

individuating

Question 3

reread required paper

Answer 3

• for every 1000 primary care visits, there are approximately 20 diagnostic errors, from which 1 patient will seek unplanned medical help within 2 weeks

Question 4

About 75% of diagnostic errors have a cognitive component.(5) The two overarching cognitive components are:

Answer 4

(i) the tendency to seek only as much information as necessary to form an initial clinical impression, and (ii) the tendency to stick with the initial impression even as new information becomes available.

Question 5

he failure to consider alternative diagnoses after the initial impression is formed

Answer 5

Premature closure

Question 6

the tendency for clinicians to stick with the initial impression even as new information becomes available

Answer 6

anchoring,

anchoring bias = inadequate adjustment of probabilities as new disconfirming information becomes available.

Question 7

the tendency to selectively seek information that supports initial impressions

Answer 7

confirmation bias,

Question 8

status quo bias

Answer 8

clinicians tend to stick with initial impressions as the number of new possible alternative diagnoses increases

Question 9

the tendency to be affected by how information is framed or presented

Answer 9

framing effect

Question 10

Interventions to reduce diagnostic errors

Answer 10

Cognitive awareness

System-based improvements

Question 11

Take-Home Points

Answer 11

• Anchoring is the tendency to stick with initial impressions even as new information becomes available.
• Anchoring could be reduced if clinicians:
• Explicitly consider base rates (prior probabilities), sensitivity, and specificity of diagnostic tests and maneuvers when diagnosing common clinical conditions.
• Actively seek information that could refute the current provisional diagnosis.
• Frame their diagnostic thinking to avoid premature diagnostic labeling and share uncertainty.
• Use system-based interventions including structured diagnostic assessments, diagnostic decision support, or computerized expert diagnostic systems.