The diagnostic reasoning for clinical diagnoses involves the collection of data and application of systematic approaches to formulating hypotheses and create lists of different diagnoses. However, sometimes the clinician can make errors that that have a direct impact on the way they handle a patient leading to incorrect diagnoses, treatments and overall management plan. Most medical errors are identified as systemic and are usually solved using various interventions as checklists. However, there are other errors that occur during diagnosis and treatment, and these are attributed to flawed diagnostic reasoning (Wellbery, 2011).
Diagnostic reasoning errors are mostly caused by heuristics or biases. Biases are usually applied in clinical diagnosis since they offer practical shortcuts for clinical evaluation, and in most cases, they lead to correct diagnosis. These diagnostic biases are widely documented in literature, and most are based on the notion that certain diseases occur much more often, and that a single diagnosis that accounts for multiple symptoms is better than considering several explanations. However, sometimes, biases could be misguided leading to erroneous diagnosis/conclusions (Wellbery, 2011). Some of the common diagnostic reasoning errors based on bias include the availability heuristic, anchoring heuristic, and framing.
In the availability heuristic, the clinician comes up with a diagnosis using the conclusion that comes to the mind most easily or based on what he/she has observed recently. This kind of reasoning can be helpful when there is a high prevalence of a particular disease such as influenza, but it can result in diagnostic errors in some cases. For example, a patient experiencing crushing test pains is treated incorrectly for a heart attack (myocardial infarction) while there are clear indications of an aortic dissection (Ebell, 2017; AHRQ, 2016).
Anchoring biases occur when a clinician relies on their earlier diagnostic perceptions despite the fact that there are clear indicators showing this diagnosis is false (AHRQ, 2016). For example, when a clinician continues to treat a non-responsive ring-like skin lesion using anti-fungal medicine, only to later discover that the lesion is DLE (Discoid lupus erythematosus) (Wellbery, 2011). Finally, framing heuristic errors occur when a clinician makes diagnostic decisions based on subtle cues, assumptions and other collateral information that supports a particular diagnosis (AHRQ, 2016; Wellbery, 2011). For example, assuming that a patient exhibiting malaria-like symptoms has malaria just because they recently arrived from Africa (Wellbery, 2011).
References:
AHRQ. (2016). Diagnostic Errors | AHRQ Patient Safety Network. Psnet.ahrq.gov. Retrieved 22 January 2017, from https://psnet.ahrq.gov/primers/primer/12/diagnostic-errors
Ebell, M. (2017). Common errors in clinical reasoning. Ebp.uga.edu. Retrieved from http://ebp.uga.edu/courses/Chapter%201%20-%20Diagnostic%20process/5%20-%20Common%20errors.html
Wellbery, C. (2011). Flaws in Clinical Reasoning: A Common Cause of Diagnostic Error. American Family Physician (AFP), 84(9), 1042-8.
