Cognitive bias: Its influence on clinical diagnosis
In a busy practice, it’s helpful to be aware of specific psychological tendencies that influence diagnostic reasoning and can lead to error.
PRACTICE RECOMMENDATIONS
› Acquire a basic understanding of key cognitive biases to better appreciate how they could interfere with your diagnostic reasoning. C
› Consider using a differential diagnosis generator as a safeguard if you suspect an increased risk of diagnostic error in a particular patient. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Differential diagnosis generators.
However, few randomized controlled studies have investigated whether the use of a DDx generator reduces diagnostic error, and evidence is lacking to prove their usefulness in clinical practice. Furthermore, while an exhaustive list of possible diagnoses may be helpful, some proposed diagnoses may be irrelevant and may distract from timely attention being paid to more likely possibilities. Additionally, forming an extensive DDx list during every patient encounter would significantly add to the physician’s workload and could contribute to physician burnout.
Selective use? We believe that DDx generators would be best used selectively as a safeguard for the clinician who becomes aware of an increased risk of diagnostic error in a particular patient. As previously discussed, errors involving cognitive processes are more often errors of improper reasoning rather than of insufficient knowledge.3 The DDx generator then serves as a way of double-checking to ensure that additional diagnoses are being considered. This can be especially helpful when facing patients who display difficult behaviors or when the clinician’s cognitive reserve is depleted by other factors.
DDx generators may also help the physician expand his or her differential diagnosis when a patient is failing to improve despite appropriately treating the working diagnosis.
Another option worth studying? Future studies could also investigate whether discussing a case with another clinician is an effective way to reduce cognitive biases and diagnostic errors.
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