What causes doctors to misdiagnosis a medical condition? After all, they are trained to diagnose and treat all kinds of medical conditions and we expect them to keep us safe and to accurately diagnose us so that we can prevent avoidable harm. They are taught in medical school to use the differential diagnosis method to diagnose and treat. This process involves (1) identifying possible causes of a patient’s symptoms; (2) identify those causes that can be life-threatening; and (3) rule-out life-threatening conditions before assuming that the symptoms are benign or not life-threatening. When presented with various signs and symptoms, a doctor typically applies the differential diagnosis. But what happens when doctors assume or are impacted by cognitive bias?
A recent article in the New England Journal of Medicine addresses the effect of cognitive bias in reaching incorrect diagnoses. It was noted that the rate of diagnostic errors is estimated to be between 10% and 15%, with the rate highest for specialties such as emergency medicine, family medicine, and internal medicine where patients are not adequately evaluated from a differential standpoint. The human mind is known to be vulnerable to cognitive biases, logical fallacies, false assumptions, and other reasoning failures, which include doctors medical clinicians (there are more than 100 biases affecting clinical decision. In a series of fatal cases, the diagnosis of pulmonary embolism was missed 55% of the time, many of which were due to cognitive bias where the doctor arrived at the wrong diagnosis because of assumptions based upon past experience, and acted reflectively rather than using analytical reasoning that involves conscious, deliberate, slower and generally more reliable decision making.
The article goes on to point out that many doctors are unaware of their biases due to defense mechanisms that prevent them from examining their thinking and slowing down in the process of diagnosing a condition. Doctors don’t like to be told they are wrong especially by patients and once they intuitively arrive at the (wrong) diagnosis, they are often reluctant to change their thought process. This is especially dangerous when the wrong diagnosis can lead to death or serious bodily harm.
When doctors assume a diagnosis and don’t listen to the patient or don’t order tests to rule-out life-threatening conditions, medical errors occur. We recently handled a case where a doctor assumed that the condition was a virus and failed to order tests that would have proven the doctor wrong. More importantly, because of the assumptions made, the patient suffered profound life-changing injuries that should have and could have been averted by ordering tests to rule-out a bacterial cause for the condition.
When doctors slow down and use analytical reasoning in attempting to make the correct diagnosis, errors are reduced. When errors are reduced, medical injuries are prevented. When medical errors are prevented, the need to file a lawsuit is averted.
The New England Journal of Medicine article provides the following example of possible negative consequences of intuitive reasoning in the clinical setting: when a primary care physician trusts his intuition that his patient’s chest pain is not a cardiac event, he will usually be correct, but not always. If he is wrong and doesn’t rule out a cardiac event, he will fail to prevent a cardiac death in given cases. One death that could have been prevented by analytical thinking is one too many!!
In contrast, analytical reasoning is conscious, deliberate, slower, and generally reliable; it follows the laws of science and logic and more likely to be rational. However, analytical reasoning is more resource-intensive, takes time and would be impractical to employ in each clinical decision. Using the same example of a patient experiencing chest pain, when the patient undergoes an analytic assessment for his chest pain in a cardiac clinic that results in angiography, the conclusion is more reliable and usually is accurate. The more accurate the diagnosis the less likely medical injuries will occur.
When doctors make medical errors that cause preventable injuries, they are frequently due to this concept of cognitive bias. If you or a loved one believes that a doctor made a diagnostic error and didn’t carefully listen and take the time to rule-out dangerous and life-threatening conditions and you suffer an injury, call us. At Mishkind Kulwicki Law, we have the resources and the expertise to get your questions answered and where appropriate, to hold the medical care provider responsible when cognitive bias gets in the way of the doctor doing his job properly
