Cognitive Errors and Diagnostic Mistakes Jonathan Howard

Cognitive Errors and Diagnostic Mistakes

A Case-Based Guide to Critical Thinking in Medicine Jonathan Howard, MD Neurology and Psychiatry NYU Langone Medical Center New York, NY USA

ISBN 978-3-319-93223-1 ISBN 978-3-319-93224-8 (eBook) https://doi.org/10.1007/978-3-319-93224-8

Library of Congress Control Number: 2018948736

© Springer International Publishing AG, part of Springer Nature 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Acknowledgment

There are many people without whom this book would not be possible. First of all, I would like to thank Pat Croskerry for being a pioneer in the field of cognitive biases in medicine. His encouragement and thoughts have been invaluable through- out this process. I am grateful that he let me use his definition of many of the cognitive biases. I would like to thank Steven Novella, Harriet Hall, David Gorski, and the entire team at Science Based Medicine. Their work has taught me an enormous amount about skepticism and critical thinking. I would like to thank “Fallacy Man” at “The Logic of Science” and Erik at “Contrive Platitudes” for letting me use their brilliant memes and cartoons. Thanks to GM at, “I Fucking Hate Pseudoscience,” for letting me borrow some of his writing. Cindy Harlow deserves angel wings for proofreading and helping to arrange the references along with Allyson Reid. Carol Lynn Curchoe and Dana Bigelow provided invaluable help and suggestions. I would like to thank Gregory Sutorius and the production team at Springer Publishing for recognizing that a book on biases was worth writing in the first place. Finally, I would like to thank my parents and wife for their support and encouragement.

v Disclaimer

None of these cases are real; though many are based loosely on actual cases, names, ages, and genders were changed. In every case, I invented key aspects to make a point. When pictures of people were used, these were obtained from free imaging sites, and there is no relation between the actual person and the medical case.

vii Contents

1 Introduction �� 1 Summary �� 1 Errors in Medicine �� 2 Cognitive Biases �� 4 Cognitive Biases in Medicine �� 7 This Book �� 8 2 Ambiguity Effect �� 15 3 Bandwagon Effect and Authority Bias �� 21 Social Loafing and Diffusion of Responsibility �� 41 Reactance Bias �� 46 4 Confirmation Bias, Motivated Cognition, the Backfire Effect �� 57 Belief Bias �� 75 5 Curse of Knowledge �� 89 6 Decision Fatigue �� 93 7 Feedback Sanction �� 103 8 Financial Bias �� 109 Mere Exposure Effect and Norm of Reciprocity �� 122 9 Forer Effect �� 139 10 Framing Effect and Loss Aversion �� 145 Sunk Costs, Endowment Effect, Choice-Supportive Bias �� 150 Anchoring Effect �� 155 Contrast Effect �� 163 11 Affective Error �� 169 Attribution Biases: The Fundamental Attribution Error and Self-Serving Bias �� 183

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12 Gambler’s Fallacy and Hot Hand Fallacy �� 203 13 Hasty Generalization, Survival Bias, Special Pleading, and Burden of Proof �� 211 Survival Bias, Special Pleading, and Burden of Proof �� 225 14 Hindsight Bias and Outcome Bias �� 247 False Memories �� 254 15 Illusionary Correlation, False Causation, and Clustering Illusion �� 265 16 In-Group Favoritism �� 285 17 Information Bias �� 303 18 Nosology Trap �� 307 19 Omission Bias �� 321 Commission Bias �� 327 20 Overchoice and Decision Avoidance �� 345 21 Overconfidence Bias �� 351 22 Patient Satisfaction Error �� 369 23 Premature Closure: Anchoring Bias, Occam’s Error, Availability Bias, Search Satisficing, Yin-Yang Error, Diagnosis Momentum, Triage Cueing, and Unpacking Failure �� 379 Introduction �� 379 Anchoring Bias �� 379 Occam’s Error �� 386 Availability Heuristic �� 389 Search Satisficing �� 396 Yin-Yang Error �� 404 Diagnosis Momentum �� 406 Triage Cueing �� 408 Unpacking Failure �� 414 Failure-To-Close Error �� 417 24 Representativeness Bias �� 425 Base Rate Neglect �� 429 Zebra Retreat �� 438 25 Screening Errors �� 445 26 Selection Bias and Endowment Effect �� 457 Introduction �� 457 Application Steps �� 457 27 Semmelweis Reflex �� 467 Galileo Fallacy �� 473 Contents xi

28 Systems Errors �� 501 Alarm Fatigue �� 501 Defensive Medicine �� 506 Graded Clinician Error �� 511 The Electronic Medical Record Error �� 514 29 Blind Spot Bias �� 525 30 Research Errors �� 537 Introduction �� 537 Expectation Bias �� 538 P-Hacking and HARKing �� 541 File Drawer Effect/Publication Bias �� 546 Poor Surrogate Outcomes �� 547 Non-Representative Study Populations: �� 548 Citation Plagiarism �� 549 Lack of Replication �� 549 Predatory Publishers �� 551 Conflicts of Interest �� 553 Legal Threats �� 554 Ghostwriting �� 555 Fraud �� 556 Solutions �� 559 Conclusion �� 565

Index �� 577 About the Author

Jonathan Howard is a neurologist and psychiatrist at NYU and Bellevue. He is the director of neurology and Bellevue Hospital and the neurology clerkship coordinator.

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