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Study links surgeons, physicians, providers not listening to patients to diagnostic errors

Cognitive bias and communications errors are dangerous

A major medical malpractice carrier completed a closed claims study, which concluded that communication is one of the top contributing factors involved in medical malpractice claims. The study also identified cognitive bias as playing a major role in many diagnostic errors.

Could it really be that communication creates major problems for highly educated and trained health care professionals? In my experience, yes.

Think about it.

What’s scary and unfamiliar to patients is nothing more than an everyday routine to physicians, physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), registered nurses (RNs), and other health care providers. That’s why there’s a temptation among doctors and health care providers to zone out while patients are talking or explaining what’s going on that brought them to the hospital or clinic.

Sometimes physicians and providers allow themselves to be lulled into thinking that they already know everything a patient is going to say before they actually say it. This is a form of cognitive bias that some psychologists call fundamental belief perseverance. It can happen to everyone, not just people in the healthcare industry. Once a belief is formed, this cognitive bias could cause the believer to consider all supportive and opposing evidence to support the belief. It’s easy to see how this would be a dangerous phenomenon in a health care setting.

I experienced this recently during an office visit with a specialist physician about a pesky big toe pain. About five seconds into my explanation about how the medial side of my big toe hurt, the rheumatologist physician interrupted me to start peppering me with questions. I could tell that she had already figured out in her mind—without hearing anything from me—that I had gout.

I answered her questions and she looked a little confused and asked the same questions again. Knowing about fundamental belief perseverance and cognitive bias, I couldn’t help but smile. I told her that I know that she’s thinking it was gout, but I already knew that was wrong because of lab work. When she was finally quiet for long enough to listen to what I had to say, the visit got back on track. (By the way, we never did figure out what was causing the toe pain. Fortunately, it went away).

I think all of this illustrates how healthcare truly is a collaborative mix of science and art. One of the key collaborators is the patient. That means that doctors and providers must make the extra effort to listen. Even though patient encounters are routine to health professionals, each patient has unique information about his or her condition that’s important to be heard, analyzed, and understood.

In the closed claims study I referenced above, they defined cognitive errors as reflecting the constraints of human processing-signaling, incomplete knowledge, flawed reasoning, or faulty reasoning. The study concluded that healthcare providers use mental shortcuts to simplify complex clinical decision-making, but that these shortcuts are often flawed and can lead to missed diagnoses and adverse events.

The study delved into some of the most common diagnostic errors among general surgeons, including:

• Malignant neoplasm of digestive organ

• Enteritis and vascular insufficiency

• Other diseases of intestines and peritoneum (intestinal obstruction and ruptured colon, for examples)

• Postoperative complications

• Neoplasm of breast

The study concluded that the following diagnostic errors were common in the different phases of health care by general surgeons.

Initial Diagnostic Assessment

• Failure to appreciate signs, symptoms, and test results

• Failure or delay in ordering diagnostic test

• Failure in establishing a differential diagnosis

Follow-Up and Coordination

• Failure or delay in obtaining a consult or referral

• Failure in communication among providers regarding patients condition

• Patient nonadherence to follow-up plan

The study recommended identifying where communication breaks down and making deliberate efforts to prevent it. The study also recommended that physicians and healthcare providers train themselves to overcome, rather than rely on intuition, in order to make better clinical decisions. One tip included using checklists to reduce diagnostic errors, because these tools have been shown to lead to more reliable and safe diagnoses.

Has your health care from a Texas hospital, physician, or provider been impacted because of poor communication or because they just wouldnt listen to you? If you had a serious health-related injury in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for a free consultation about your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.

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