AAO-HNS14: Medical Bias Explored As Cause of Medical Errors

by Thomas R. Collins •

Things like bringing in a second surgeon, having a conference before a surgery, and other simple measures can be taken to try to prevent those kinds of errors. “Those things actually serve the purpose of trying to reduce the possibility of bias in a decision, but we haven’t understood it using that language,” Dr. Arjmand said.

Farrel Buchinsky, MD, a pediatric otolaryngologist at Allegheny General Hospital in Pittsburgh, said he likes the collegial approach to preventing errors. “I’ve read many books on these topics, and they’re all about you and what you can do for yourself, but what I found most useful was how you can build it into your team approach and how you can rely on your colleagues,” he said. Talking to colleagues about errors, without notes, as they do at Dr. Shapiro’s center, helps physicians overcome their reluctance to let down their guard, he said.

Additionally, he thought panelists were wise to underscore the importance of bringing a second physician into the operating room. “You think you’re bringing him in because you need a second pair of hands,” he said. “You need a second brain, and more importantly than a second brain, a brain that hasn’t gone through what you’ve just been going through for the past half hour or an hour.”

Take-Home Points

  • Most mistakes don’t come about because of a lack of knowledge but from biases in decision making.
  • Offering physicians involved in errors a chance to discuss the situation with colleagues in an unthreatening environment can be a good way to prevent future errors.
  • “Near misses” might be more important than errors that cause harm in teaching lessons about avoiding mistakes.
  • Veteran physicians should make a point of teaching their own decision-making processes to residents and others who are learning.

Biases Found in Diagnosis

  • 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 preconceived opinion, rather than looking for information to prove oneself wrong.
  • Diagnosis momentum: Accepting a previous diagnosis without sufficient skepticism.
  • Overconfidence bias: Overreliance on one’s own ability, intuition, and judgment.

Source: Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78:775-780.