Teaching your ‘old-dog brain’ new tricks can help you combat all medical biases and be a better vet!
In Parts 1 & 2 of this series we discussed the Top 10 medical biases we see in veterinary medicine:
1. ANCHORING/DIAGNOSIS MOMENTUM
2. ASCERTAINMENT BIAS
3. AVAILABILITY BIAS
4. COMMISSION/OMISSION BIAS
5. CONFIRMATION BIAS/WISHFUL THINKING BIAS
6. OUTCOME BIAS
7. PREMATURE CLOSURE/SEARCH SATISFACTION BIAS
8. SUNKEN COSTS BIAS
9. TRIAGE BIAS
10. BELIEF BIAS
In this part we will discuss how to combat medical biases in general, as many more medical biases exist!
HOW TO COMBAT MEDICAL BIASES:
1. LEARN ABOUT BIASES:
Just by knowing biases exist you will decrease your likelihood of falling into these bias traps. Also, by actively assessing your own tendency for particular biases, you will be able to actively combat these biases and have better case management and outcomes!
2. SLOW DOWN:
Taking just 1-2 minutes more to ensure you are being thorough and not rushing to just get ANY answer, but to get the CORRECT answer, is vitally important!
“Think twice, cut once”. By not trying to jump right to the answer, and by slowing down and forcing yourself to work through the process of every case, no matter how simple, you are much less likely to miss/ignore pieces of information, or jump to a diagnosis too soon.
3. METACOGNITION AND CONSIDERING ALTERNATIVES:
SHOW TO BE THE BEST at decreasing rates of cognitive errors, actively thinking ‘What else could it be?’ is the #1 way to decrease falling into the medical biases traps, and decreasing your rate of misdiagnoses.
4. CHECK LISTS:
Check list are shown to be the best way to decrease errors in SURGERY. WHO surgical saftey checklists have significantly decreased the complications and mortality associated with surgeries. This was also shown as effective reducing adverse events in veterinary anaesthesia.
5. ASSUME 1ST DIAGNOSIS IS WRONG:
Start at the beginning of a case and re-assess all information, assuming your first diagnosis is wrong. This will actively make you think ‘What else could it be?’, and will make you look for a different cause for all of the data you collected.
6. ROUND CASES PROPERLY:
When rounding cases to colleagues, don’t start with the diagnosis and fly through the information. Give an accurate, detailed history and sequence of events, so that you are not placing your idea of the diagnosis on your colleague. One of the best side-effects of 24hour centres and different vets on shifts on the same case, is that you get more brains thinking about the case, with different view-points. Don’t cloud their opinion with yours, and let them think through the case themselves to see if they can get a better idea of what is going on!
7. REMEMBER WE CAN BE WRONG!
Knowing and awknowleding that we can be fallible is important! It is OK that we will be wrong sometimes, and that is the point of tests and colleagues.
Also, M&M rounds for cases that didn’t go as well as possible are great learning opportunities for groups so everyone can learn from everyone else’s mistakes, decreasing the overall mistakes made and improving patient care!
“Mistakes are a fact of life. It is the response to error that counts.”- Nikki Giovanni
One of the hardest aspects in veterinary medicine of properly training our Pattern Recognition is getting a definitive diagnosis. So often we are limited as to what tests can be performed, and we try empirical therapy. We then make an assumption about the diagnosis, and either the animal gets better because of us, despite us, or we euthanize based on a presumed bad diagnosis and grave prognosis. To make ourselves feel better, we assume our diagnosis was correct.
If we can increase our post-mortem rate we can better learn about when we were right and wrong, and better train our Pattern Recognition.
This is obviously difficult due to clients emotions and finances, but something to consider as making a culture in your clinic.
9. REPORT ERRORS:
Reporting errors, both globally and also by sharing and learning from our mistakes through M&M Rounds, we can all grow collectively as a profession!
Having databases where veterinarians can report errors, where mistakes are logged and trends can be found to help create systems that will help on a global scale, is desperately needed! The biggest barrier to this is fear of punishment, and also our egos where we don’t want to admit we have made mistakes.
Talking about our mistakes, and learning from each others’ mistakes, on both clinic and global levels, will help progress the profession!
This is a future goal of KICK ASS VETS! To create an anonymous database to collect information on mistakes, so that we can better learn and grow from each other.
10. TEACH DECISION MAKING:
It is very important that in our schools and in our clinics we are teaching the process of decision making. Decision making is the back-bone of medicine, and is a skill that can be taught and learned. School is so information heavy that it rarely addresses the decision making processes that are required to truly think and be successful as a vet.
Mentoring new graduates in this area should be a priority, and one that is based on Evidence Based Medicine!
11. ALGORITHMS/SYSTEMATIC APPROACH:
Algorithms, systematic approaches or charts/tables, that remove the ‘human bias component’ will help us decrease both or incidences of missing things, as well as remove biases that result in our feelings about patients, treatments or tests.
Having a set method for your physical exam, that you perform in every single case, will help prevent you from missing that tick on the ataxic daschund! Having a set method for reading x-rays, and templates in your record that you need to fill out for each radiographic study, will help you miss that inguinal hernia just because you found a bone in the stomach.
Creating templates, systems and algorithms will help your clinic not only run more smoothly, which decreases employee stress and burn-out and helps with staff retention, but will help decrease mistakes and improve your patient care!
By addressing specific medical biases, and approaches that can be taken in general to improve our approach to cases, we can improve how we practice and who we are as veterinarians.
Accept that you are human, and accept that biases will exist, and then actively combat them! Your patients will thank you for it!
If you feel your clinic, team, student group, or any other group is suffering from these biases and would benefit from a presentation on how biases exist and how we can combat them, please feel free to Contact Us at anytime to arrange a presentation.