Education of the Week

There have been a rash of interesting cases at the South lately. Attached is one of them. This case (a bounceback) was chosen not only for the medical learning points, but the cognitive ones as well.

Emergency medicine relies heavily on heuristics- simple decision strategies that ignore part of the available information, basing decisions on only a few relevant predictors, potentially leading to bias/cognitive errors. These can be useful tools provided one is aware of the pitfalls. Below are a few of the biases that might have come into play in this case (it will make more sense once you read the case).

Anchoring bias: heavy reliance on the first piece of information received/inability to adjust diagnosis when confronted with contradictory information

eg “it’s my sciatica”
Confirmation bias: tendency to favor information that supports initial diagnosis/search for evidence that supports the initial diagnosis and ignore contradictory evidence 

Representative heuristic: judging the likelihood of a diagnosis based on similarity to a stereotype or typical case, may overlook relevant details
eg “it’s just another back pain/sciatica like the other 10 back pain patients from today,” “everyone here has the flu”
Decision-making bias: gut decision relying on intuition or recognition based on past experience, used to make rapid decisions
eg “it’s super busy, give motrin/robaxin and discharge”

Try to keep these in mind, especially when it's busy.

Charlotte Reich, MD FACEP

South to North transfer specialist