Doctor Bias Is Real – and It’s a Serious Problem

Doctor bias is a real problem that often leads to medical malpractice claims. It occurs for various reasons, one of which being the doctor simply makes a diagnosis based on what he or she has seen recently in other patients, instead of what’s wrong with the patient in the room at the time. There are no finite numbers on how often doctor bias occurs, but some estimates state that it happens 5% to 10% of the time in emergency rooms.

There are 4 common types of bias, as reported in Becker’s Hospital Review:

  1. “Anchoring biasis the tendency to rely too heavily on one piece of information or idea — usually the first — when making decisions.
  2. Wishful thinking biasis the idea that people believe in what they want to be true. This bias could cause someone to overestimate the rewards while underestimating the risks of certain decisions.
  3. Confirmation bias is the tendency to look for information that confirms one’s preconceptions, often while dismissing information that may challenge them.
  4. Availability heuristic is the tendency to overestimate the likelihood of events that are more readily available in one’s memories.”

Today, we wanted to look at some real world scenarios where these types of biases may lead to a misdiagnosis.

The doctor has seen multiple patients with the same condition

A common cause of doctor bias in diagnosing patients is that the doctor has seen multiple patients prior to your visit with similar symptoms as you. The doctor recognizes the symptoms and issues a diagnosis of, for example, an upper respiratory infection because it is “going around” at the time. In issuing this diagnosis, the doctor may fail to take a patient’s history into account, or ignore symptoms that don’t fit in the diagnosis.

A constellation of findings steer the diagnosis

There are times when the doctor has a “constellation of findings” after examining a patient that steer the diagnosis in the wrong direction despite a thorough evaluation. In the case of upper respiratory infection vs bronchitis, what would the findings be? For most patients, the symptoms that present include the following:

  • Deep, violent cough
  • Inability to lay down flat
  • Wheezing
  • Required use of a nebulizer
  • Use of a rescue inhaler
  • Shortness of breath
  • Sore stomach and ribs due to coughing
  • Body aches
  • Headaches
  • Nasal congestion

Many of these symptoms present in patients who have bronchitis or who have an upper respiratory infection, making it easy for a doctor to mistakenly diagnose a patient with either of these two medical issues. The constellation of findings can often lead to a frame that the doctor uses to steer clear of other possible diagnoses.

How to prevent diagnostic errors and doctor bias

It is challenging to address doctor bias; a systemic review of diagnostic processes would be required, and medical professionals may be unwilling to take the time to perform it. Doctors are forced to take shortcuts each day, because there isn’t enough time to explore all the possible diagnoses that can be issued. History shows them that they are usually right, and it ends up feeing into an echo chamber.

Recommendations have been made to teach doctors about doctor bias and diagnostic errors so that they can recognize these issues and learn how to avoid them with their patients. Another recommendation has been made for the use of checklists in every patient care room, to ensure all requisite tests have been completed.

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