I visited with a San Antonio critical care physician today who is serving as a medical expert witness in a pending case that I’m handling. We had an interesting conversation about bias in the medical profession.
In recent years, psychologists have made huge leaps in their research and understanding of how bias works for all of us. Doctors and nurses are no different, but when bias interferes with their decision making the stakes can be high—even deadly.
This doctor shared a story about a patient he cared for several years ago in San Antonio. A middle-aged patient went to a hospital emergency room. She smelled of alcohol. The emergency room doctors and nurses concluded that she was unresponsive because she was drunk and needed to be admitted to a hospital until she sobered up.
That hospital was full, so they called our physician expert to see if he could admit her to a different hospital overnight. He agreed.
When this woman arrived at the second hospital, the doctor went to see her. He immediately noticed the smell of alcohol that the physician and nurse at the emergency room had noticed. Then he did an exam and, to his shock, immediately discovered that she had a gun shot wound to her stomach. He ordered a surgical consult, the patient was taken to the operating room, and it saved her life.
Physician and healthcare bias
There are several types of bias that psychologists believe creep into healthcare:
* Anchoring bias: This is giving too much weight to one piece of information. This often happens when it’s the first information about a patient provided to a doctor or nurse.
I represented a client in a medical malpractice lawsuit where this was a big issue. During the holiday season, she had been to an office party where there was an open bar. The next morning, she felt nauseated and a bit woozy. Her boyfriend saw her suddenly slump over and develop one-sided facial droop and weakness, and slurred speech. He called 911 and the ambulance crew concluded she was just having a hangover.
They took her to a major comprehensive stroke center hospital in the Texas Medical Center, where the emergency medical technicians (EMTs) shared their thoughts. That anchoring bias caused the resident, attending physician, and nurses to overlook the clear, textbook stroke symptoms that were right in front of her. They quickly concluded that it was all “in her head” and sent her home. A few days later, she went to another hospital and was diagnosed with a massive stroke—but it was too late to treat it with the clot-busting drug tPA. That’s how powerful anchoring bias is!
* Wishful thinking bias: This is the tendency of people to gravitate toward positive situations, rather than negative ones. In medicine, there are signs and symptoms that are related to a lot of different conditions, some serious and others not serious.
Take, for example, a headache. I had a case where a man went to an emergency room three times complaining of the worst headache of his life. All three times, he was misdiagnosed with a migraine headache and discharged. On the last date, he went home and had a devastating stroke a short time later.
Doctors can overcome the impact of wishful thinking bias by following a process that they’re taught in medical school, called differential diagnosis. When physicians see a patient, they’re required to take a history of the complaints and come up with a list of the potential conditions or diagnoses that could explain the symptoms. Then they must order tests or perform a further examination to rule out or rule in each condition, starting with the most dangerous one.
By allowing bias to overcome the differential diagnosis, doctors needlessly endanger their patients.
* Confirmation bias: This bias works in a tricky way. Once a person forms an opinion, confirmation bias tends to make the person latch onto consistent evidence and dismiss or overlook contrary evidence. In fact, some psychologists have found that unchecked confirmation bias can cause a person to become more stubborn in his or her initial opinion when contrary evidence is presented.
Confirmation bias can impact health care when a doctor has rushed to a conclusion and won’t listen to a patient or family member who questions the diagnosis or provides additional information for consideration.
* Availability bias: This works when a doctor or nurse over-emphasizes the importance of events that are in front of them, while discounting prior events.
What you can do
It’s important for doctors and nurses to be familiar with how bias can affect their decision making. Unfortunately, they’re sometimes numb to this reality.
If you find yourself in this situation, then you should make sure that you repeat all the necessary information to your doctor and nurse and, if needed, insist on a second opinion.
If you’ve been seriously injured because of bias playing a role in poor medical decision-making, then contact a competent, top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.