2021_Book_TextbookOfPatientSafetyAndClin

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M. L. Regina et al.
Table 17.5 (continued)
Bias Description Example Corrective strategy
Multiple alternative
bias
Outcome bias
Frequency gambling
bias and worst-case
bias
Posterior probability
error
Search satisfying
bias
Sunk cost bias a
Visceral bias
Commission bias
To reduce differential
diagnosis to few more
familial hypotheses, when
multiple options are
available
To opt for the diagnosis
associated with the best
outcome, valuing more
physician hope than
clinical data
In ambiguous clinical
picture, to opt for a benign
diagnosis, assuming
benign diseases are more
common.
It is opposite to the
worst-case bias
To assume that a patient
presenting with the same
symptoms has always the
same disease
In presence of a main
diagnosis, to stop to look
for secondary ones.
In this way, the physician
will miss comorbidities,
complications, and
additional diagnoses
The tendency to pursue a
course of action, even
after it has proved to be
suboptimal, because
resources have been
invested in that course of
action
To opt for a diagnosis
being influenced by
emotions
Tendency to do something
even if it is not supported
by robust evidence and
may in fact do harm
The physician missed a rare
diagnosis of familial
Mediterranean fever and
submitted the patient to surgery
for appendicitis
The physician interpreted as
benign a lung nodule, instead to
order further investigations
The physician interpreted the
poly-globulia as reactive rather
than as a proliferative disorder in
a heavy smoker
The physician diagnosed heart
failure instead of pulmonary
embolism in a patient presenting
with dyspnea and a repeated
hospital admissions for heart
failure
To attribute to hypertensive heart
disease the atrial fibrillation
occurred in a patient with
essential hypertension, missing
hyperthyroidism
The physician continued to look
for a cancer in a patient with
fatigue, even if investigations are
repeatedly negative
“Do not cling to a mistake just
because you spent a lot of time in
making it” Aubrey De Graf
The physician attributed
iron-deficiency anemia to
hypermenorrhea in a patient her
age without looking for bowel
diseases
The physician complied with the
request for lumbar puncture of the
parents of an 18-year-old girl with
fever and headache to rule out
meningococcal meningitis
although the neutrophil count was
normal. The girl then developed a
severe post-puncture headache
and was admitted to hospital
Utilize an objective tool,
such as a differential
diagnosis checklist
Verify if diagnosis
correlates with technical
findings
Broaden the history to
search for other causes or
associations
Use a differential
diagnosis checklist and
rule out worst-case
scenario
Consider prevalence and
incidence of any
hypothesis
Consider always evidence
and balance benefits and
risks