Profiles in Patient Safety: Confirmation Bias in Emergency Medicine

Abstract

Confirmation bias is a pitfall in emergency care and may lead to inaccurate diagnoses and inappropriate treatments and care plans. Because of the increasing severity and volume of emergency care, emergency physicians often must rely on heuristics, such as rule-out protocols, as a guide to diagnosing and treating patients. The use of heuristics or protocols can be potentially misleading if the initial diagnostic impression is incorrect. To minimize cognitive dissonance, clinicians may accentuate confirmatory data and ignore nonconfirmatory data. Clinicians should recognize confirmation bias as a potential pitfall in medical decision making in the emergency department. Reliance on the scientific method, Bayesian reasoning, metacognition, and cognitive forcing strategies may serve to improve diagnostic accuracy and improve patient care.ACADEMIC EMERGENCY MEDICINE 2006; 13:90-94 ª

Understanding Decision Making in Critical Care

“…36 Thus, diagnostic information that trickles in slowly rather than all at once may unconsciously strengthen an initial belief or hypothesis. Receiving a patient with a provisional diagnosis from another physician may likewise incline one to confirm rather than reformulate the diagnosis.…”

“…Receiving a patient with a provisional diagnosis from another physician may likewise incline one to confirm rather than reformulate the diagnosis. 36 The latter is a huge problem particular to critical care, as information is constantly being passed back and forth between operative teams, consultants, on and off shift nurses, and physicians. We frequently admit patients who come attached to a long trail of impressions and existing care plans, both of which have been shown to constrain diagnostic thinking.…”

Echo chambers, confirmation bias and polarization of ideas: how scientific and non-scientific knowledge spreads around the Web 2.0

“…L'altradeterminantedelleecho chambers è il confirmation bias.Anchechiamatopregiudizio di conferma,consistenella tendenzadell'essereumanoaselezionaresololeinformazioniaffinialleproprieconvinzionipiùprofondeeainterpretare le notizie in modo da alimentare i propri preconcetti. È un costrutto psicologico onnipresente in politica, in economia, nellapraticamedicaescientifica,eanchenelweb (17). Tutto avvieneperchéogniindividuohalatendenzanaturaleacon-servare il proprio sistema di credenze e ad affidarsi ciecamenteaesso.Èunaquestionearcaicadisopravvivenza.Ad esempio,quandounsoggettoaccedeauntestoscrittooaun eventoportaconséunaseriedi"pre-comprensioni"e"pregiudizi"chesonolasuaunicaveraviapercapire.Inpratica ancheiltestopiùoggettivovieneinterpretatodachilegge.È la Teoria della comprensione diGadamer (18).…”

Denying Antecedents and Affirming Consequents: The State of the Art

“…In other ordinary situations, however, the consequences may amount to decisions between life and death. For instance, the role of cognitive errors, including biases and the improper application of heuristics, in medical misdiagnoses is well documented (Croskerry, 2003;Elstein, 1999;Graber, 2005;Mendela et al, 2011;Normal and Eva, 2010;Pines, 2006). Further, while debiasing is a uniquely difficult task (Kenyon, 2014;Willingham, 2011), at least some progress is being made, particularly in fields like medicine where the stakes are highest.…”