Cognitive Bias and Medical Errors

what is cognitive bias?

aka heuristics, is a subconscious and cognitive short cute that one applies to a complex situation to make decision making easier.

what is the problem with cognitive bias?

it is associated with diagnostic error and swaps accuracy for time and efficiency

which thinking process is associated with cognitive bias?

inductive thinking process

why do we have cognitive biases?

Cognitive biases arise from the brain's attempt to simplify information processing, leading to quicker decision-making but often at the cost of accuracy and critical analysis.

what are the origins of cognitive bias?

bc we are human! it is dual processing in our thinking and a push-pull between our logical brain and our experiential brain

is it common or uncommon to have a lack of insight into our own biases?

common

what are potential causes of cognitive bias, and is it associated with intelligence?

causes: learned or innate, social and/or cultural, lack of appreciation for statistics and mathematical rationality, environment has competing interests for our attention. its not associated with intelligence

what is availability bias?

when you think the obvious solution in the right one

what is confimation bias?

when you interpret exam findings to fit a pre-conceived diagnosis/hypothesis

what is representation bias?

misinterpretation of symptoms based on the likelihood of even given population and pt presentation

what is overconfidence bias?

inflated ability of your diagnostic ability

what is search satisfying bias?

ceasing to look for further information or alternative answers once the first plausible solution is found

what is diagnostic momentum bias?

continuing a clincal course of action instigated by previous clinicians without considering the information available and changing the plan if required (particularly if commenced by more senior clinicians)

what is base rate neglect bias?

when the underlying incident rates of conditions or population based knowledge is ignored as if they do not apply to the patient in questions (like if the base rate of smth is so low that the possibility of it being true is basically ignored)

what is conjunction rule bias?

the incorrect belief that the probability of multiple events being true is greater than a single event (a simple and unifying explanation is statistically more likley than multiple unrelated explanations)

how can we mitigate bias?

1. slowing down- shift to deductive approach

2. metacognition- think and reflect, ask why, seek alternative theories

3. checklists

is the evidence for formal teaching on bias and statistics strong or weak?

weaker

how are cognitive bias and medical erros associated?

cognitive bias lead to medical errors, there is potential for errors at all levels of patient encounters

what percentage of error in internal medicine practice are cognitive in origin?

78%

what percentage of diagnostic errors are cognitive in origin?

28%

what was the significance of the publishing of the book “To Err is Human”?

The book highlighted the prevalence of medical errors in healthcare and called for a national debate on patient safety, leading to initiatives aimed at reducing errors and improving safety through design of a safer heath system. Discouraged finger pointing and encouraged transparency.

how can systems be built to mitigate error?

build systems that anticipate error and are built with multiple barriers- such as technology, processes, and people which is designed to stop active errors (defense in depth)

what factors can we be aware of to develop a culture of safety?

personal (cognitive loading, fatigue, affective considerations), patient (complex presentation, number of comorbities, lack of complete history), and system factors (the design of the organization itself)

how should systems be built to create an organization of safety?

build systems that are non-punitive, patient safety training, transparent information sharing and reporting, team building, provides resources, and investigates errors and changes processes accordingly