By learning about, and blocking our own tendencies to make mistakes, we can be better vets!
Recap from Part 1:
Medical Biases and Cognitive Errors are present in about 80% of medical misdiagnoses, and lead to harm in 12% or greater of our patients.
By being aware of these biases and putting in practices to actively combat them, we can improve our medicine and improve patient care!
In Part 1 we discussed:
1. ANCHORING/DIAGNOSIS MOMENTUM
2. ASCERTAINMENT BIAS
3. AVAILABILITY BIAS
4. COMMISSION/OMISSION BIAS
5. CONFIRMATION BIAS/WISHFUL THINKING BIAS
6. OUTCOME BIAS:
This bias is how we judge our colleagues or clients. Hindsight is 20/20. When assessing a case referred from another clinic, or worked up by a colleague, we are often very harsh and judge that colleague strongly based on the information know NOW, instead of the information they knew THEN.
We see this often when GP and Referral centres judge one another (the did too much, they did too little, etc.) and when we deal with online trolls.
COMBAT THIS BIAS:
- Always assess any case and past history based on the information, and resources, available AT THAT TIME.
- Never assume you know what conversations were had with owners, or what the patient looked like before it was in your care.
- GREAT RECORDS: To help everyone know the details of your case, and why your clinical judgement and treatment plan was pursued, have amazing records and INCLUDE CLIENT COMMUNICATIONS! Not only will this help in case of any form of litigation, but it will help everyone taking over your case to know exactly what was going on, and will help decrease both you from being judged, and you from judging others (when you read their detailed records).
7. PREMATURE CLOSURE/SEARCH SATISFACTION BIAS:
Most commonly seen in radiology, this bias occurs when you stop looking for another diagnosis when you have found an ‘answer’.
Let's Get Personal
I saw a dog that was sore walking/going up stairs. I examined the dog, obviously not well enough, and found nothing abnormal on physical exam. I took x-rays and found a bone in the stomach. Thinking the bone could be poking the stomach and causing pain (this was reaching and also displaying Confirmation Bias), I made the dog vomit, bone came up, and I sent the dog home.
The dog returned later, still painful, and my colleague found an inguinal hernia. Actually, to be specific, my nurse pointed out the weird lump in the groin to my colleague, who diagnosed the inguinal hernia.
I missed this by displaying both Confirmation Bias and Premature Closure Bias. I could have properly diagnosed this by slowing down, properly assessing both my physical exam and by completely interpreting the x-rays, because the hernia could be seen on the first x-ray.
Fortunately no harm aside from a few hours of discomfort came to this patient, and there was no strangulated bowel, however it could have been bad!
COMABT THIS BIAS:
- SLOW DOWN
- Have a Systematic Approach that is consistent and complete EVERY CASE (for physical exams, interpreting bloods, ultrasound, x-rays, etc)
8. SUNKEN COSTS BIAS:
Going down with a sinking ship can happen without us knowing when we refuse to look for different diagnoses because we are emotionally invested in a diagnosis.
This bias is hard for us as vets given the nature of the clients paying for the tests and interventions. This is when we are reluctant to let go of a diagnosis and accept a possible different diagnosis due to invested time and money into a particular diagnosis. Both our egos, guilt and finances play into this bias.
Ex. Daschund with ataxia has an MRI that is normal.… then you find the paralysis tick.
COMBAT THIS BIAS:
- Recongize that diseases can look the same
- Remove your ego and guilt- this is part of medicine
- SLOW DOWN
- Have a systematic approach to decrease the chance of missing things
- Explain the value of ‘negative tests’ to owners.
9. TRIAGE BIAS:
How an animal is triaged, either by owners, reception or nursing team, or another doctor even, will affect our perception of a case. A diagnosis or severity of a case placed into your mind by another will affect how severe you assess that animal.
Ex. Limping Dog: An owner coming in screaming that her dog is in severe pain is triaged as more severe, and more painful, and more likely to be given a dose of pain relief before full assessment, than a calm owner that comes in and patiently sits and waits for an exam.
COMBAT THIS BIAS:
- Have Triage Algorithms in your clinic
- SLOW DOWN
- Systematic Approach to each case
10. BELIEF BIAS:
Accepting or rejecting data, information or a treatment plan based on our personal belief of a test or intervention. This is especially true in veterinary medicine when definitive diagnosis are very often not obtained due to financial limitations, therefore we rely on our ‘experience’ (Anectdotal medicine) to form opinions.
Ex. Whether or not you believe Tramadol works, will affect how you pain score an animal after giving that drug.
COMBAT THIS BIAS:
- Be aware of personal biases to actively combat them
- Systematic Approach and Algorithsm for subjective things (Ex. Pain Score charts)
- Pursue Evidence Based Medicine instead of Anecdotal as much as possible
Summary:
In Part 1 & 2 of this series we have discussed the top 10 medical biases that we see day-to-day in veterinary medicine. These biases are present, whether we want to admit it or not, so by actively addressing and combatting these biases we can help progress the profession and improve our patient care.
In Part 3 we will address how to combat medical biases as a whole, as there are more than just these 10 biases...
If you feel that you may be suffering from Medical Biases, or if you feel that your team or clinic may be suffering, and a presentation with a Q&A or webinar on these biases and how we can combat them please feel free to Contact Us at anytime.
