A 2005 study published in Archives of Internal Medicine found that a cognitive error on the part of a physician, often referred to as “premature closure,” is the single most common cause of diagnosis errors. Premature closure occurs when a clinician arrives at an initial diagnosis that seems to fit the presentation of the patient, and fails to consider other reasonable possibilities based on inconsistent symptoms, testing or medical history.
A physician often begins to make conclusions about the cause of a patient’s problems within minutes of presentation, often before even conducting an examination. Research shows that most physicians quickly formulate possible diagnoses based upon “pattern recognition” and by relying upon hunches based on incomplete information. Using this type of pattern recognition to arrive at a diagnosis is mental processing based upon using shortcuts – known in psychology as “heuristics.”
Doctors, being human, often stereotype their patients. Unfortunately, stereotyping can cause a doctor to jump to an incorrect conclusion. This is known as an “attribution error.” For example, a doctor may presume that a young female patient’s debilitating headaches are the result of adolescent stress or related psychological issues. Once a doctor attaches firmly to a diagnosis, known as “anchoring,” he may fail to take into consideration other inconsistent factors, such as the timing of the headaches, frequency, and any conditions that may affect the intensity or duration of the headaches. The cognitive error that causes doctors to ignore contradictory information and focus only on the information consistent with an initial and potentially incorrect diagnosis is known as “confirmation bias.” Cumulatively, these thinking errors may result in the failure to consider and test for a much more serious cause of the patient’s condition, resulting in misdiagnosis or delayed diagnosis and a consequent failure to provide necessary treatment in a timely manner.
Many of my clients’ cases have involved misdiagnosis as the result of cognitive errors. Cognitive errors also account for how a patient may be misdiagnosed by more than one physician. Subsequent treating doctors may be influenced by the initial diagnosis of the original doctor and may also anchor to the incorrect diagnosis engaging in confirmation bias. Dr. Jerome Groopman has written a fascinating book that addresses the type of cognitive errors addressed in this piece entitled, “How Doctors Think.”