Can a mini review of a working diagnosis with another doctor reduce cognitive bias?
Hospital Emergency Departments (EDs) are busy environments where clinicians must quickly and accurately diagnose cases that are often complex and where they are not familiar with the patient.
In this environment there is a risk of misdiagnosis, which can affect patients receiving timely and appropriate care. While Australia faces similar issues to other Western counties, estimates suggest that diagnostic errors happen in 10-15% of cases.
One of the main contributing factors to misdiagnosis is cognitive bias (the mental shortcuts we all use), which can influence clinician decision-making, leading to diagnostic errors, poor patient outcomes and possibly even deaths.
Cognitive bias is thought to be at play in more than three-quarters of misdiagnosis cases, with two biases being:
- anchoring bias, where clinicians lock onto salient information early in the patient’s presentation and fail to adjust this impression in light of further information and,
- premature closure, where the investigative process ends too early and disconfirming information is not sought.
To address the issue, we developed and trialled a Rapid Diagnostic Discussion (RaDD) tool to encourage clinicians to have a structured discussion about the possible causes of abdominal pain – the most frequent presentation to Victorian EDs.
For an overview of the trial, view the video below.