Pitfalls from Psychology Science that Worsen with Practice

Shafir

2022

Med Decis Making

Self Cite

Background Diagnostic reasoning requires clinicians to think through complex uncertainties. We tested the possibility of a bias toward an available single diagnosis in uncertain cases. Design We developed 5 different surveys providing a succinct description of a hypothetical individual patient scenaric. Each scenario was formulated in 2 versions randomized to participants, with the versions differing only in whether an alternative diagnosis was present or absent. The 5 scenarios were designed as separate tests of robustness using diverse cases, including a cautious scenario, a risky scenario, a sophisticated scenario, a validation scenario, and a comparative scenario (each survey containing only 1 version of 1 scenario). Participants included community members ( n = 1104) and health care professionals ( n = 200) who judged the chances of COVID infection in an individual patient. Results The first scenario described a cautious patient and found a 47% reduction in the estimated odds of COVID when a flu diagnosis was present compared with absent (odds ratio = 0.53, 95% confidence interval 0.30 to 0.94, P = 0.003). The second scenario described a less cautious patient and found a 70% reduction in the estimated odds of COVID in the presence of a flu diagnosis (odds ratio = 0.30, 95% confidence interval 0.13 to 0.70, P < 0.001). The third was a more sophisticated scenario presented to medical professionals and found a 73% reduction in the estimated odds of COVID in the presence of a mononucleosis diagnosis (odds ratio = 0.27, 95% confidence interval 0.10 to 0.75, P < 0.001). Two further scenarios—avoiding mention of population norms—replicated the results. Limitations Brief hypothetical scenarios may overestimate the extent of bias in more complicated medical situations. Conclusions These results demonstrate that an available simple diagnosis can lead individuals toward premature closure and a failure to fully consider additional severe diseases. Highlights Occum’s razor has been debated for centuries yet rarely subjected to experimental testing for evidence-based medicine. This article offers direct evidence that people favor an available simple diagnosis, thereby neglecting to consider additional serious diseases. The bias can lead individuals to mistakenly lower their judged likelihood of COVID or another disease when an alternate diagnosis is present. This misconception over the laws of probability appears in judgments by community members and by health care workers. The pitfall in reasoning extends to high-risk cases and is not easily attributed to information, incentives, or random chance.

Section: Introductionmentioning

confidence: 99%

“…3 Such conflicting perspectives around diagnostic simplicity and complexity abound in daily medical practice and will not end soon. 4…”

Section: Introductionmentioning

confidence: 99%

The Fallacy of a Single Diagnosis

Shafir

2022

Med Decis Making

Self Cite

“…Large hospitals can mitigate these fears by offering formal channels for relaying feedback (yet some channels merely bury feedback in bureaucracy). An inevitable difficulty in offering support, however, is that institutions and observers all have biases of self‐preservation and make inadequate corrections for these biases in themselves 22 . Juniors, seniors, and observers, moreover, have dissimilar strengths that facilitate the display of knowledge and the concealment of deficiencies.…”

Section: Discussionmentioning

confidence: 99%

Honest communication and social asymmetries inside a hospital: Pitfalls for clinicians

Journal of Hospital Medicine

2022

Self Cite

One opportunity for speaking candidly to a senior person may arise in a large group setting where multiple junior individuals have an opportunity to talk. Such town-hall arrangements have merits since they can offer a substantial sample of those in a lower hierarchical position. Large groups also provide the appearance of being inclusive, allow institutions to claim to have contacted many stakeholders, and require less total time for the authorities compared to their attending multiple separate sessions.A large group also involves minimal effort for individuals who are disengaged, seriously fear backlash, or feel too timid to voice grievances.An important limitation of a large group setting, however, is that early speakers can set the tone, hijack the agenda, and may leave others silent. This limitation is termed the "cascade of social influence." 7 A classic example of the cascade of social influence tested music tastes in young adults by rating songs of unfamiliar musicians. 8 Half How to cite this article: Redelmeier DA, Etchells EE, Najeeb U. Honest communication and social asymmetries inside a hospital: Pitfalls for clinicians.

“…This means that spreading inaccurate characterizations may be particularly destructive for a listener who is gullible or easily provoked. 37 Conversely, gossip can also lead to anxiety about future uncertainties. 38…”

Section: Gossip and The Receivermentioning

confidence: 99%

“…Gossip, of course, can also lead to a positive thrill where, for example, a recipient subsequently feels emboldened with passionate enthusiasm to relay the point to others. This means that spreading inaccurate characterizations may be particularly destructive for a listener who is gullible or easily provoked 37 . Conversely, gossip can also lead to anxiety about future uncertainties 38 …”

Section: Gossip and The Receivermentioning

confidence: 99%

Principles and Practice of Gossiping About Colleagues in Medicine

Journal of Hospital Medicine

Etchells

Najeeb

2021

You are signing over to a colleague on the COVID-19 inpatient hospital ward. You are stressed after having failed to reach the chief medical resident who did not respond despite repeated texts. You think about mentioning this apparent professional lapse to your colleague. You pause, however, because you are uncertain about the appropriate norm, hesitant around inding the right words, and unsure about a mutual feeling of camaraderie.