Table 2.
Types of Cognitive Biases and Tools to Address Them
| Cognitive bias | Definition | Example | Tools to address bias |
|---|---|---|---|
| Anchoring bias | Tendency to fixate and base decisions on initial evidence 23 | Fixating on a type A septic etiology of LA and overlooking type B LA |
Utilize a stepwise schema as a tool for redirection For example, in working up lactic acidosis 2: (1) Evaluate for adequate perfusion (2) Systemic work up for local ischemia (3) Remove potential agents (4) Check for thiamine deficiency (5) Consider other metabolic etiologies |
| Availability bias | Recent events amplified by an emotional component “prime” the physician to focus on a diagnosis 23 | The preponderance of patients with sepsis and type A LA during the COVID-19 pandemic increase might justify focus on type A LA | |
| Confirmation bias | Tendency to interpret new data to fit the presumed diagnosis 23 | Excessive infectious workup to support type A LA causes despite scant clinical evidence of infection | |
| Conjunction fallacy | The belief that multiple events are more probable than a single process 14 | The persistent search for a cause of sepsis in addition to DKA, with less emphasis on how DKA could drive LA | Bias-specific teaching sessions to prompt clinicians to prioritize a unifying diagnosis over concurrent separate processes 14 |
| Diagnostic momentum | Tendency to maintain a clinical course of action initiated by the prior care team 23 | Continued emphasis on a type A LA etiology throughout her hospitalization despite transferring of services | Diagnostic time-outs to review and synthesize all data and consider alternative disease process 14 |
| Base rate bias | Failure to consider underlying incidence rates of conditions 23 | Very low likelihood that a clinically well-appearing, hemodynamically stable 21-year-old patient was in occult shock | Consider pre-test probability as well as magnitude of abnormal test to maximize clinical utility 24 |
| Heuristics and illness scripts | Mental shortcuts in which an illness/diagnosis becomes associated with a pattern of presenting symptoms and/or a particular demographic 21,22 |
Thiamine deficiency is primarily associated with older men with alcohol use disorder 25–28 Gaps in knowledge about the prevalence of thiamine deficiency in patients with DKA further exacerbates this bias |
Practicing metacognition and questioning one’s own thinking process, as well as continuous medication education to fill in gaps 14 |