Week 3 - G - Cognitive erros in diagnosis (aka cognitive bias, cognitive disposition to repsond) Flashcards
State what the definition is referring to?
Predictable tendencies, or biases, to react to contextual clues that are largely unconscious and may contribute to flaws in reasoning and diagnostic error
This definition is referring to cognitive dispositions to respond aka cognitive biases
Cognitive dispositions to respond make diagnostic error a greater possibility
We will give examples of different cognitive dispositions to respond (cognitive biases) and you state the term which best matches the definition
- when physicians believe that aggregated data, such as those used to develop clinical practice guidelines, do not apply to individual patients (especially their own), they are invoking the aggregate fallacy. The belief that their patients are atypical or somehow exceptional may lead to errors of commission,
What is an example of this?
This is known as aggregate bias - the belief that the data used to develop clinical practice guidelines does not apply to specific patients
e.g., ordering x-rays or other tests when guidelines indicate none are required.
What term matches this definition?
:the tendency to perceptually lock onto salient features in the patient’s initial presentation too early in the diagnostic process, and failing to adjust this initial impression in the light of later information
Anchoring is the tendency to lock onto salient (the most noticeable) features in the patient’s initial presentation too early in the diagnostic process, and failing to adjust this initial impression in the light of later information
occurs when a physician’s thinking is shaped by prior expectation
What is this?
What is a good example?
This is known as ascertainment bias - stereotyping and gender bias are good examples of ascertainment bias -occurs when a physician’s thinking is shaped by prior expectation
Define gender bias?
What does it result in the overdiagnosis and underdiagnosis of?
Gender bias: the tendency to believe that gender is a determining factor in the probability of diagnosis of a particular disease when no such
pathophysiological basis exists.
Generally, it results in an overdiagnosis of the favored gender and underdiagnosis of the neglected gender.
: the disposition to judge things as being more likely, or frequently occurring, if they readily come to mind. Thus, recent experience with
a disease may inflate the likelihood of its being diagnosed.
Conversely, if a disease has not been seen for a long time, it may be underdiagnosed.
What is this?
Availability - disposition to judge things are more likely or frequently occuring if they readily come to mind.
the tendency to look for confirming evidence to support a diagnosis rather than look for disconfirming evidence to refute it, despite
the latter often being more persuasive and definitive.
What is this?
Confirmation bias - look for evidence to confirm a potential diagnosis rather than looking for discomforming evidence to refute it
What is diagnostic momentum?
This is when a diagnosis is given to a patient as a differential usually
However what might started as a possibility gathers increasing momentum until it becomes definite, and all other
possibilities are excluded.
the tendency to be judgmental and blame patients for their illnesses (dispositional causes) rather than examine the
circumstances (situational factors) that might have been responsible. In particular, psychiatric patients, minorities, and other marginalized groups
tend to suffer from this CDR
What is this?
How can you word it easier?
Fundamental attribution error - tendency to attribute the cause of the illness tot he patient rather than examining situation factors that may have led to the condition - particular in psychiatric and marginalised groups
What is gambler’s fallacy?
Gamblers fallacy - : attributed to gamblers, this fallacy is the belief that if a coin is tossed ten times and is heads each time, the 11th toss has a greater
chance of being tails (even though a fair coin has no memory)
- Tendency to believe that a particular chance event is affect by previous events and that chance events will even out in the short run - ie if a clinican is in a chest pain and clinic and continually diagnoses ACS, the clinician assumes this is less likely to be diagnosed in the future
What is outcome bias?
What may this result in?
Outcome bias: the tendency to opt for diagnostic decisions that will lead to good outcomes, rather than those associated with bad outcomes, thereby
avoiding chagrin associated with the latter. It is a form of value bias in that physicians may express a stronger likelihood in their decision-making for what they hope will happen rather than for what they really believe might happen.
This may result in serious diagnoses being minimized.
What is overconfidence bias?
Overconfidence bias is the basis to act on incomplete information eg intuition or hunches
It is the tendency to think we know more than we do
What term is this definition describing?
occurs when a physician’s estimate for the likelihood of disease is unduly influenced by what has gone on before for a
particular patient.e.g., if a patient presents to the office five times with a headache that is correctly diagnosed as migraine on each visit, it is the tendency to diagnose migraine on the sixth visit.
Posterior probability error - Common things for most patients continue to be common, and the potential for a nonbenign headache being diagnosed is lowered through posterior
probability
What is posterior probability error the opposite of?
It is the opposite of the gambler’s fallacy in that the physician is gambling on the sequence continuing,
