Josephine Volkmann
English 151
Due
Cognitive bias in the medical field
It is believed that diagnostic errors are associated with six to seventeen percent of adverse
events in hospitals which are attributed to cognitive bias or knowledge deficit. Cognitive bias is
the systematic thought process caused by the brain to simplify processing information through a
filter of personal experiences, knowledge, and value. Many researchers believe a knowledge
deficit affects doctors' and nurses' decision-making. Professor Geoffrey Norman, Department of
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, and Canada
believes that decision-making errors stem from the lack of knowledge medical professionals
possess and the limited capacity of working memory the brain can hold. Other researchers, such
as Satish V. Khadilkar, head of the Department of Bombay Hospital and Medical Research
Center, and Dr. Croskerry, associate professor of the Department of Emergency Medicine and
Medical Education, give credit to cognitive bias and unique situations for decision-making
errors. Both of these sides have something in common; cognitive bias is impossible to avoid.
I.
Human memory plays an important role in decision-making, especially in the medical
field.
A. “The brain has a limited amount of working memory capacity, also called
short-term memory,” which means doctors and nurses can only remember so
much at a time leading to errors. Norman
1. There is only a certain amount of items the human working memory can
hold.
2. “The capacity of working memory is pretty low: between three and five
information “chunks.”Johnson
3. “The capacity of human working memory typically rises as we develop
from babies into adults and begins to decline when we are in our 30s.”
4. As doctors age it becomes more difficult to pull information into their
working memory, slowing them down and possibly making the wrong
decisions.
B. During the reasoning process stored information within long-term memory is
brought into the working memory to help nurses and doctors make decisions
faster.
C. Certain memories or past experiences can be harmful to physicians when
making quick decisions.
1. Faster decisions using past memories and experiences are harmful if the
outcomes of those memories are not thoroughly examined.
2.
This includes the memory being a past experience that was non-medical
related and will harm the decision or a fact from studying that will help
diagnose a patient.
II. On the other hand, many people say cognitive bias is to blame for doctors' and nurses'
medical decision-making errors.
A. Cognitive Bias affects the analytic process where reasoning and clinical decisions occur
causing every situation to be unique.
1. “28 percent of adverse events in the hospital have been proven to be attributed to
cognitive bias errors.”Khadilkar
2. There are many factors that increase the likelihood of making cognitive errors.
3. “These include cognitive overload, high decision density, sleep deprivation, and
emotional situations.”
B. Any cognitive error could result in the belief that a correct decision has already been made
and prevent further verification.
1. Once the “diagnosis has been made, the thinking stops.” This happens before all
of the information has been gathered and exploring other alternatives to the issue.
Morgenstern
2. Protocol error is a cognitive bias that is often overlooked. It is the “tendency to
judge the likelihood of a diagnosis based on a typical prototype of the disease
symptoms.'' Any atypical presentation of a disease is likely to be missed because
every option is not considered when a certain disease looks to be the most likely
option. Morgenstern
3. “Once a diagnostic label has been assigned to a patient by another individual, it is
very difficult to remove that label and interpret their symptoms with fresh eyes.”
III. A characteristic that these sides have in common is cognitive bias is impossible to avoid.
A. Cognitive bias is the brain's attempt to be efficient and quickly make decisions,
which can help think through a patient's case quickly and find a diagnosis.
1. “These mental shortcuts exist to make our brains more efficient, but they
also create systematic errors in our way of thinking.” Klynn
2. These systematic errors occur because our brain relies on our perceptions,
observations, and experiences, not actual facts.
B. Cognitive bias affects physicians' ability to gather and interpret evidence and take
action while evaluating their decisions.
1. “Although the relation between decisions and outcomes might seem intuitive, the
outcome of a decision cannot be the sole determinant of its quality; that is, sometimes a
good outcome can happen despite a poor clinical decision, and vice versa.”smith
2. Medical education can invest in cognitive bias training, the role that the biases play in
diagnostics and treatment errors, and effect debiasing strategies.
3. One way of learning to deal with and notice bias for physicians is a guided reflection
intervention which “involves searching for and being open to alternative diagnoses and
willingness to engage in thoughtful and effortful reasoning and reflection on one’s own
conclusions, all with supportive feedback or challenge from a mentor.” smith
Decision-making errors in the medical field are hard to avoid. There is an argument about
the leading causes of these errors which is whether a knowledge deficit or cognitive bias is the
main reason. If physicians are not being taught the correct materials and cannot retain the
information they use then they are at a knowledge deficit when trying to help patients. If
physicians are making errors because of their personal experiences and values then it is cognitive
bias at fault. There are some people who believe that it is both of these things that are causing so
many errors and they need to be brought to the attention of physicians.
Work Cited
Timothy M. Smith. “4 Widespread Cognitive Biases and How Doctors Can Overcome Them.”
American Medical Association, 4 Feb. 2021,
/delivering-care/ethics/4-widespread-cognitive-biases-and-how-doctors-can-overcome-th
em. Accessed November 10 2023.
Johnson, Jeff. “Human Working Memory.” Human Working Memory - an Overview |
ScienceDirect Topics, 2017,
sciencedirect.com/topics/computer-science/human-working-memory. Accessed
November 10 2023.
Khadilkar, Satish V, and Suvarna S Khadilkar. “Bias in Clinical Practice.” Journal of Obstetrics
and Gynaecology of India, U.S. National Library of Medicine, Feb.
2020,/pmc/articles/PMC6982612/#. Accessed November 19 2023.
Klynn, Bethany. “Betterup Blog.” BetterUp, July 2021,/blog/author/bethany-klynn-phd.
Accessed November 15 2023.
Mandell, Brian F. “Clinical Decision-Making Strategies - Special Subjects.” Merck Manuals
Professional Edition, Merck Manuals, 12 Nov. 2023,
merckmanuals.com/professional/special-subjects/clinical-decision-making/clinical-decisi
on-making-strategies. Accessed November 19 2023.
Morgenstern, Justin. “Cognitive Errors in Medicine: The Common Errors.” First10EM, 22 Sept.
2019, first10em.com/cognitive-errors/. Accessed November 15 2023.
professor, Dr. Croskerry is associate. “The Importance of Cognitive Errors in Diagnosis and... :
Academic Medicine.” LWW, Apr.
2017,/academicmedicine/fulltext/2003/08000/the_importance_of_cognitive_errors_in_di
agnosis.3.aspx. Accessed November 10 2023.
professor, G.R. Norman is emeritus. “The Causes of Errors in Clinical Reasoning: Cognitive... :
Academic Medicine.” LWW, Jan.
2018,/academicmedicine/fulltext/2017/01000/the_causes_of_errors_in_clinical_reasonin
g_.13.aspx. Accessed November 21 2023.