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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Triage. Show all posts
Showing posts with label Triage. Show all posts

Friday, August 18, 2023

Evidence for Anchoring Bias During Physician Decision-Making

Ly, D. P., Shekelle, P. G., & Song, Z. (2023).
JAMA Internal Medicine, 183(8), 818.
https://doi.org/10.1001/jamainternmed.2023.2366

Abstract

Introduction

Cognitive biases are hypothesized to influence physician decision-making, but large-scale evidence consistent with their influence is limited. One such bias is anchoring bias, or the focus on a single—often initial—piece of information when making clinical decisions without sufficiently adjusting to later information.

Objective

To examine whether physicians were less likely to test patients with congestive heart failure (CHF) presenting to the emergency department (ED) with shortness of breath (SOB) for pulmonary embolism (PE) when the patient visit reason section, documented in triage before physicians see the patient, mentioned CHF.

Design, Setting, and Participants

In this cross-sectional study of 2011 to 2018 national Veterans Affairs data, patients with CHF presenting with SOB in Veterans Affairs EDs were included in the analysis. Analyses were performed from July 2019 to January 2023.

Conclusions and Relevance

In this cross-sectional study among patients with CHF presenting with SOB, physicians were less likely to test for PE when the patient visit reason that was documented before they saw the patient mentioned CHF. Physicians may anchor on such initial information in decision-making, which in this case was associated with delayed workup and diagnosis of PE.

Here is the conclusion of the paper:

In conclusion, among patients with CHF presenting to the ED with SOB, we find that ED physicians were less likely to test for PE when the initial reason for visit, documented before the physician's evaluation, specifically mentioned CHF. These results are consistent with physicians anchoring on initial information. Presenting physicians with the patient’s general signs and symptoms, rather than specific diagnoses, may mitigate this anchoring. Other interventions include refining knowledge of findings that distinguish between alternative diagnoses for a particular clinical presentation.

Quick snapshot:

Anchoring bias is a cognitive bias that causes us to rely too heavily on the first piece of information we receive when making a decision. This can lead us to make inaccurate or suboptimal decisions, especially when the initial information is not accurate or relevant.

The findings of this study suggest that anchoring bias may be a significant factor in physician decision-making. This could lead to delayed or missed diagnoses, which could have serious consequences for patients.

Friday, March 27, 2020

Coronavirus and ethics: 'Act so that most people survive'

Georg Marckmann
dw.com
Originally posted 24 March 20

Here is an excerpt:

Triage, a word used in military medicine, means classification. What groups do you classify the patients into?

There are several categories. Critically-ill patients are treated immediately, the treatment of seriously-ill patients is delayed, and patients who are slightly ill are treated later. Patients with no chance of survival receive purely palliative care.

The crucial element of situations involving a large number of sick people that we can no longer care for adequately is that we have to switch from a patient-centered approach to a group- or population-oriented approach. In a patient-centered approach, we try to adjust treatment as best we can to ensure the well-being of the individual patient and accommodate their wishes.

In a group-centered approach, we try to ensure that the incidence of illness and death within a population group is as low as possible. This places a strain on those making these decisions, because they're not used to it.

As a basic rule, we try to act in such a way that the largest number of people survive, because that is in the public interest.

The info is here.