When medical-decision making goes awry

There is a very sad case report in today's New York Times that describes a missed case of S. pyogenes sepsis in a 12-year-old boy.  The initial diagnosis of viral gastroenteritis resulted in an ER discharge that delayed therapy.  Our very own Mike Edmond discusses the case in the article.

We've all lost sleep at night since we first started medical school worrying about cases like this.  It's pretty easy to fall into the false belief that we can avoid these misses in the care of our own patients, but sadly we're all susceptible to the frailties of the human mind and cognitive biases.

Some of the biases that I think impacted this sad case were highlighted in a 2010 American Medical News article by Kevin O'Reilly and include:

• Anchoring bias – locking on to a diagnosis too early and failing to adjust to new information. 
• Availability bias – thinking that a similar recent presentation is happening in the present situation. 
• Confirmation bias – looking for evidence to support a pre-conceived opinion, rather than looking for information to prove oneself wrong. 
• Diagnosis momentum – accepting a previous diagnosis without sufficient skepticism. 
• Overconfidence bias – Over-reliance on one’s own ability, intuition, and judgment. 
• Premature closure – similar to “confirmation bias” but more “jumping to a conclusion”

Until diagnostic systems can be designed that can help prevent these biases from intruding on our decision making, sadly these horrible cases might not be 100% preventable.