Pediatric emergency medicine trisk 0080 0080

TABLE 1.5 EXAMPLES OF COMMON COGNITIVE BIASES IN EMERGENCY MEDICINE Type of bias Definition/example Anchoring bias Premature closure; failure to consider reasonable alternatives once diagnosis has been made: Examination and labs consistent with acute abdomen; pneumonia not considered despite new data of tachypnea and cough Availability Judge things as being more likely if they readily come to bias mind: Fever, vomiting, and benign abdominal examination must be viral enteritis Blind Authority effect inhibits trainees: Medical student worried obedience about high heart rate—told its “OK” and patient has myocarditis Diagnostic Once labels are attached, they become “sticky”: Colleague momentum signed out patient with “gastroenteritis” and you miss appendicitis despite concerning labs and evolving examination Framing Clinician accepts framing provided by others: Patient is triaged as low acuity so must not be sick Judgmental Stereotyping: This young mother does not have insurance and keeps seeking ED care—the child does not have a “real” problem Listening Hearing only the opening statement and conclusion and omission accepts it as full story: 20th case presented by trainee of child with vomiting Wait and see Not actively seeking an answer: wait and see if the child can drink and what happens when the fever resolves Strategies to reduce cognitive error and improve decision making include thinking out loud and encouraging others to add their impressions or thoughts Identification of one’s assumptions, avoiding “premature” closure when making complex or critical decisions, and challenging oneself about