BY: Andy Dragovic | IN: Medical Malpractice
When doctors make mistakes, the results can be devastating. Errors can occur at any time during treatment, from the initial consultation and diagnosis to long-term ongoing care decisions. While mistakes occur for many reasons, developing research may indicate that some deep-seated cognitive biases can lead to predictable, preventable mistakes. Could these mental errors lead to a cognizable medical malpractice claim?
“Cognitive bias” refers to a pattern of deviation from factual reality or objective input in determining an individual’s responsive behavior; stated simply, a cognitive bias happens when someone makes a bad choice they think is a good choice.
Certain types of cognitive biases are shaped by a person’s past experiences and events rather than the evidence in front of them. As people compile their experiences, they develop shortcuts to quickly make decisions based on conclusions they’ve drawn in the past. For example, through past experiences, we understand that if a stove burner is lit, it is hot and potentially dangerous, even without touching it. This mental efficiency can be vital for doctors who must make quick decisions in emergency situations.
But cognitive biases can also lead to mistakes. A 2016 review of cognitive biases associated with medical decisions identified overconfidence, tolerance to risk, the anchoring effect, and information and availability bias as the most common biases associated with diagnostic inaccuracies and suboptimal patient care management.
“Overconfidence” is self-explanatory, but it can be a common personality trait among physicians, especially those with significant experience. “Tolerance to risk” can also result from years of experiencing successful results based on objectively risky choices. Both biases can contribute to one doctor’s decision to engage in a treatment that results in a negative outcome in a situation where other doctors would find that decision objectively unreasonable.
The “anchoring effect” is the tendency to rely too heavily on one idea or one piece of information (often the first one a doctor obtains) when making a decision. A pediatrician who receives test results showing a patient has strep throat, for example, may not look for additional evidence of a more rare disease even if a few symptoms don’t fit that diagnosis. This may often be paired with “confirmation bias,” which is the tendency to look for or accept information that fits a chosen conclusion or preconception while dismissing evidence to the contrary.
How we draw from available information can also lead to cognitive bias, such as the tendency to believe that things which readily come to mind are more representative of reality. Think about shark attacks, which are astonishingly rare – there were 140 confirmed attacks worldwide in 2019, only five of which were fatal. Yet more people were killed in the U.S. by collapsing sand holes. Information availability bias leads most people to believe that sharks are the bigger beach danger.
In the medical setting, increased media discussion of a specific disease may cause physicians to overdiagnose that disease in patients if their symptoms suggest it. In turn, a misdiagnosis of that disease could prevent the physician from accurately diagnosing a different, more acute condition and rendering treatment to cure it.
A New York Times article (subscription may be required) described various examples of cognitive bias and the unfortunate results.
In one study, patients experienced an unlikely adverse side effect of a particular drug, so the treating physician doctor was less likely to prescribe that medication for the next patient whose symptoms warranted it, even though the drug’s appropriateness had not changed. This puts patients’ health and lives at risk.
In another study, when pregnant mothers experienced an adverse event during vaginal delivery or cesarean section, the obstetrician was more likely to switch to the other delivery technique for later patients, whether or not it was appropriate for the situation. As a consequence, both the cost of treatment and negative outcomes increased.
A study about gender bias in surgeon referrals found that when a patient of a female surgeon dies, a physician who previously sent a patient to the deceased surgeon will refer fewer patients to any female surgeon in the future. The same study found that the opposite – referrals to male surgeons – was not true.
In a study published in February 2020 of elderly patients with heart disease, cardiologists were more likely to perform coronary artery bypass surgery on patients who suffered heart attacks in the two weeks before their 80th birthdays than those who suffered heart attacks in the two weeks after their 80th birthdays. Researchers hypothesized the physicians had a so-called “left digit” bias. Similar to a consumer who perceives an item priced at $4,999 as cheaper than at the same item costing $5,000, cardiologists may treat “older” patients “in their 80s” more conservatively than “younger” patients in “in their 70s,” even though the patients are essentially the same age.
Not all medical mistakes constitute malpractice, but when an error that could have been prevented – such as those from cognitive bias – injures the patient or causes their death, the doctor, nurse, or other healthcare provider who is responsible must be held liable.
In Michigan, medical professionals owe patients a duty to care for them according to what a reasonably competent and skilled healthcare professional, with a similar background and in the same medical community, would have provided. This objective standard of care prevents doctors from using cognitive bias to excuse their negligence.
If you or someone you love has been a victim of a medical error, contact an experienced medical malpractice lawyer immediately. You only have a limited amount of time to file a lawsuit, and pursuing that claim can be difficult. For more than 40 years, the attorneys in Sommers Schwartz’s Medical Malpractice Litigation Group have helped individuals and families hold doctors, nurses, hospitals, and providers accountable and get the compensation to which they are entitled.
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Andy Dragovic is a member of Sommers Schwartz's Personal Injury and Medical Malpractice Groups. His practice is 100% dedicated to helping victims get compensation for their injuries and losses.