The Acute Mind

Cognitive Biases

Definition

Cognitive biases are unconscious thinking patterns that can lead clinicians to make errors in judgement or decision making. They often occur when we over-rely on our intuitions and assumptions.

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How to Apply

Cognitive biases are especially common in AMU where the medicine is fast paced, diverse and decision dense with incomplete information. Mental shortcuts are sought out of exhaustion or time constraints. We are all guilty of being cognitively biased at one point or another. The importance is metacognition – thinking about how we are thinking. As such, when assessing patients – think:

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• Anchoring & Framing – fixation on the first diagnosis and accepting someone else’s diagnosis without thought – ‘ED said COPD’ or ‘GP said UTI’.

• Confirmation bias – only looking for evidence that supports your diagnosis and ignoring / discarding evidence to the contrary.

• Search Satisficing & Premature Closure – stopping the search after prematurely committing to a diagnosis too early – i.e. ‘its a PE. End of story.’

• Availability bias – thinking of and over-applying what you’ve seen recently to the current diagnostic thinking – i.e. recent SAH makes every severe headache seem like SAH. This is made much worse when a clinician has been affected by missing / delaying a diagnosis. Of course, no one intentionally does this and none of us can claim to be perfect – a good clinician reflects & refines their practice so they do not let that affect their future practice going forward.