In this episode I talked with Dr. Quinn Cummings (@resus_bae) about the topic of cognitive bias and some ways we can reduce the influence of biases in our practice. Quinn is an emergency physician with a special interest in this topic.
During an average shift an emergency medical provider makes hundreds to thousands of decisions. To make these decisions, our brains use a combination of conscious and subconscious information. We tend to think that all our decisions are made objectively but, in fact, much of our decision making comes from knowledge or ideas that we are not even aware of. This is the concept of cognitive bias. A cognitive bias is a systematic error in thinking which can skew our ability to process information properly and accurately. This can lead to an improper diagnosis or treatment path for our patient. There are numerous examples of specific biases such as anchoring bias, confirmation bias, premature closure, etc. We discuss a few examples in the podcast but we encourage you to research more to see which ones you may be more susceptible to (see resources below).
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References and other resources:
Croskerry, P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Academic Med. August 2003, 1-6.
Croskerry, P et al. Patient Safety in Emergency Medicine. Lippincott Williams & Wilkins, 2009.
Thomas, D. D., & Mustafa, Y. Design for cognitive bias. Jeffrey Zeldman / A Book Apart. 2020.
Croskerry P. Cognitive forcing strategies in clinical decision making. Ann Emerg Med 2003;41(1):110–120.
Croskerry P. The feedback sanction. Acad Emerg Med. 2000 Nov;7(11):1232-8. doi: 10.1111/j.1553-2712.2000.tb00468.x. PMID: 11073471.
Caplan R.A., Posner K.L., Cheney F.W.: Effect of outcome on physician judgments of appropriateness of care. JAMA 1991; 265: pp. 1957-1960.
Abraham Kaplan (1964). The Conduct of Inquiry: Methodology for Behavioral Science. San Francisco: Chandler Publishing Co. p. 28. ISBN 9781412836296.
Allison, Scott T; Messick, David M (1985). “The group attribution error”. Journal of Experimental Social Psychology. 21 (6): 563–579. doi:10.1016/0022-1031(85)90025-3
Lambe KA, O’Reilly G, Kelly BD, et al. Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. BMJ Quality & Safety 2016;25:808-820.
Benau EM, Orloff NC, Janke EA, Serpell L, Timko CA. A systematic review of the effects of experimental fasting on cognition. Appetite. 2014 Jun;77:52-61. doi: 10.1016/j.appet.2014.02.014. Epub 2014 Feb 27. PMID: 24583414.
Lowe CJ, Safati A, Hall PA. The neurocognitive consequences of sleep restriction: A meta-analytic review. Neurosci Biobehav Rev. 2017 Sep;80:586-604. doi: 10.1016/j.neubiorev.2017.07.010. Epub 2017 Jul 28. PMID: 28757454.
O’Sullivan ED, Schofield SJ. Cognitive bias in clinical medicine. J R Coll Physicians Edinb. 2018;48(3):225-232. doi:10.4997/JRCPE.2018.306