1 out of 20 patients suffer a medical mistake by their primary care physicians. This totals 12 million misdiagnoses a year nationally. Thankfully, only half of them have the potential to cause serious injury or death.
How do smart and caring doctors make such mistakes? Often it is because they are tired, busy or multi-tasking. This is done also because when faced with so much information, our brain uses processing shortcuts or “heuristics” which can save us from using mental energy. Everyone uses mental autopilots to reduce the amount information we encounter. Driving a car for miles while making decisions about speed, turns and oncoming traffic without even realizing what we are doing is a common example. Although these quick subconscious decisions produce answers usually true and help us navigate successfully through life, they can lead to a wrong answer in the physician’s office.
Certain well established biases affect our thinking. For instance, representative bias causes a doctor to judge a patient based how similar the patient is to the prototypical patient for the disease. Recency bias causes physicians to think that trends and patterns will continue. For example, during the flu season, physicians can subconsciously delay a diagnosis of pneumonia in an outpatient setting by diagnosing a fever, headache and cough as flu just like all the others in the last week. Anchoring and Diagnostic Momentum biases cause physicians to rely too heavily on earlier information; and once a diagnosis is “attached” to a patient, the diagnosis gains more acceptance and momentum as more care is provided even after an objective re-evaluation would show it to be wrong.
So, here are key questions to ask your primary care physician that can help minimize the chances for a misdiagnosis due to these biases:
1) If it is not “x”, what is the worst it could be?
2) Just because I am not at high risk, could I still have “x”?
3) What is the worst thing that could be causing my problems?
4) Are there any tests we can do to be sure of the diagnosis? Which ones?
5) If you are wrong about the diagnosis, how will we know?
Here are further queries that can help to minimize misdiagnosis that occurs as a result of anchoring and diagnostic momentum:
6) If we are not getting results, should we consider another approach?
7) I know you think I have “x”, but how can you tell if it’s not “x”?
8) How long do you expect it to take for the treatment to start working?
9) How will we know if the treatment is working?
10) I know that Dr. X said “y” but could she be wrong?
All patients must play a key, lead role in making sure their conditions are properly assessed and the correct diagnoses are made. These are fair and reasonable inquiries for your doctor and it forces your physician to use critical thinking.