Are Cognitive Biases Influencing Your Clinical Decisions?

Cognitive Dispositions to Respond
Diagnostic errors are often associated with cognitive errors such as failures in perception, failed heuristics, and biases; as a group, these cognitive errors have been labeled cognitive dispositions to respond.¹ In the medical and psychology literature, more than 100 CDRs have been identified.¹⁹ Common CDR/bias definitions are provided in the graphic.

In everyday practice, clinicians encounter clinical scenarios or situations where CDRs can affect decision making. The following brief clinical examples further illustrate the defining characteristics of the CDRs. Cognitive errors related to these CDRs can occur if a clinician does not remain completely objective.

Availability is a bias that applies the saying “more common diseases are common.” An example of this bias in practice would be a provider who has seen three patients with abdominal pain and diagnosed gastritis for each. A fourth patient presents with abdominal pain, is diagnosed with gastritis, but actually has appendicitis.

Search satisficing, or premature closure, occurs when one has found enough information to make a diagnosis and then stops looking for further causes or additional problems. For example, a PA rounds on a patient who is post-op day 1 from coronary bypass surgery and develops decreasing oxygen saturation. A chest x-ray reveals right lower lobe opacity consistent with either pneumonia or pleural effusion; antibiotics are started and oxygen concentration is increased on the ventilator. The radiologist later informs the PA that the patient also has a left-sided pneumothorax. The PA did not treat that because he stopped looking for other causes of the oxygen desaturation once the right lower lobe pneumonia was found.

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