Cognitive bias is a systematic error in thinking that influences decision making and judgement. It occurs when people are processing and interpreting information given to them. Contemporary theories of clinical reasoning suggest a dual processing model, which consists of (i) a rapid intuitive component based on personal mind lines, heuristics, beliefs, judgements and preferences, and (ii) a slower logical and analytical component based on science and rationale. The rapid intuitive component is accurate for many decisions but is vulnerable to various cognitive biases. However evidence shows that most humans prefer to use this form of reasoning whenever possible. Cognitive biases (such as availability bias, framing, confirmation bias, the anchoring effect and premature closure, affective bias, blind obedience, and overconfidence) and personal traits (such as aversion to risk and ambiguity) may be associated with diagnostic inadequacies, medical errors and sub optimal management. The ultimate consequences of medical errors are avoidable hospitalisation, medication under use and overuse, and wasted resources that may lead to patient harm. We report a case of a fourteen year old boy who presented with polydipsia, polyuria, reduced appetite and weight loss. He was managed as a case of disordered eating in a Children and Adolescence Mental Health unit for a year; spending three months of that period as an inpatient on nasogastric tube feeding. Following review as a paediatric in-patient, he was found to have pituitary dysfunction and a CT scan showed hydrocephalus with an intracranial tumour involving pituitary and pineal gland which confirmed a germinoma on histology. Errors that stem from cognitive bias may be difficult to discuss because they are personal; and acknowledging them may feel like failure. Hence, improving our understanding and awareness of our own bias is an essential first step in enhancing our understanding of clinical decision making, improving patient care, informing future research and preparing clinicians for the cognitive rigours of clinical medicine.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes