While reading an article in the Wall Street Journal by Laura Landro, The Biggest Mistake Doctors Make, I noticed a chart. It is called “Common biases that can prevent a doctor from making a correct diagnosis”. In addition to causing me great concern about the next time I have an odd symptom so visit a physician, I realized that it describes exactly the same issues that keep executives from making the right decisions.
At first I was going to discuss the article but upon further reflection realized that I should just share it as is, including leaving it in medical mode. Perhaps some of these reasons for misdiagnosis will feel familiar…and require some strong personal medicine to overcome.
The ABCs of Misdiagnosis
Anchoring: Locking on to salient features in the patient’s initial presentation too early in the diagnostic process and failing to adjust for conflicting or new information
Availability: 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
Bandwagon Effect: The tendency for people on a medical team to believe and do certain things because many others are doing so
Confirmation Bias: The tendency to look for confirming evidence to support a diagnosis rather than look for evidence to refute it, despite the latter often being more persuasive and definitive
Diagnosis Momentum: Once diagnosis labels are attached to patients, what might have started as a possibility gathers increasing momentum until it becomes definitive and all other possibilities are excluded
Fundamental Attribution Error: The tendancy to be judgmental and blame patients, especially psychiatric and minority patients, for their illnesses, rather than examine the circumstances that might have been responsible
Gender Bias: The tendency to believe that gender is a determining factor in the probability of diagnosis of a particular disease when no such bias exists
Need For Closure: Drawing a conclusion or making a verdict about something when it is still not definite, often when the doctor feels obliged to make a specific diagnosis under conditions of time or social pressure, or to escape feelings of doubt or uncertainty
Outcome Bias: The tendency to opt for diagnosis decisions that will lead to good outcomes, rather than those associated with bad outcomes
Overconfidence Bias: A tendency to act on incomplete information, intuition or hunches. Too much faith is placed in opinion instead of carefully gathered evidence
Sunk Costs: The more time and mental energy clinicians invest in a particular diagnosis, the less likely they may be to let it go and consider alternatives
Unpacking Principle: Failure to elicit all relevant information from patients in a medical history
Zebra Retreat: Occurs when a rare diagnosis, or zebra, figures prominently, but the physician retreats for various reasons: perceived inertia in the system and barriers to obtaining special or costly tests, self-consciousness and underconfidence about entertaining a remote and unusual diagnosis