8-12 There are a number of ways in which cognitive bias can be seen to play out in the covid-19 pandemic. This video explains and illustrates common cognitive biases that affect medical decision-making. Anchoring Bias. Anchoring bias can cause a clinician to prematurely settle on a diagnostic hypothesis based on initially gathered information and thereafter downplay alternative diagnostic possibilities. Medical Education 2009: 43: 721– 728 It refers to physicians’ practices of prioritizing information and data that support their initial impressions, even when first impressions are wrong. This unconscious bias, also known as implicit bias, is important in a medical setting “because it may affect decision making about how care proceeds,” she says. Cognitive bias has frequently been discussed in general healthcare environments where it may affect both patient care and staff wellbeing, 2-4 and also in science settings. This increasing awareness of bias has resulted in a surge in clinical and psychological research in the area and development of various ‘debiasing strategies’. Example The hospital you are working in as a medical student is short of beds. Psychologists Daniel Kahneman and Amos Tversky studied many of the pitfalls of heuristics, such as these: The base-rate neglect fallacy, explored in my previous post , surfaces when we misuse the anchoring and adjusting heuristic. Discrimination against patients Many types of implicit bias discriminate against patients ( box 1 ). Dr. Amori, who holds a doctorate in counselor education and a master's degree in counseling and human systems, says four types of cognitive bias are most common. A physician can anchor on a specific aspect of the history, a physical finding or a laboratory result. For example, we wrote about a case of anchoring in our November 2008 column , “Anchoring errors ensue when diagnoses get lost in translation,” where a patient’s complaint of gas caused clinicians to initially miss an abdominal aneurysm. Anchoring bias, limited differential leads to quadriplegia Spinal epidural abscess (SEA) too often overlooked Facts: A 44-year-old male with recent interferon treatment for Hepatitis C and a prior history of neck surgery with hardware sees his PCP for new onset headache, photophobia, and URI symptoms. Anchoring refers to the tendency to latch on, or anchor, to the first symptom or bit of data, leading to misdiagnosis. ... and Pamela Hartzband are staff physicians at Boston’s Beth Israel Deaconess Medical Center. cognitive bias: a study of decision making and multiple treatment alternatives in medicine. Anchoring bias reflects the undue influence that an initial impression has on the evaluation of subsequently collected information. Med Decis Making. Anchoring bias is closely related to confirmation bias and comes into play when interpreting evidence. 2006 Mar- Apr;26(2):154-61. • Wegwarth O. Smart strategies for doctors and doctors-in-training: heuristics in medicine. Authority bias Declining to disagree with an "expert." Anchoring refers to the tendency to latch on, or anchor, to the first symptom or bit of data, leading to misdiagnosis. Further studies are needed to identify what the most common cognitive biases and the most effective strategies to overcome their potential influence of medical tasks and errors. Physicians who exhibited information bias, anchoring effects and representativeness bias, were more likely to make diagnostic errors [38, 43, 46, 50]. Like a medical procedure, heuristics can have both risks and benefits. Cognitive bias is increasingly recognised as an important source of medical error, and is both ubiquitous across clinical practice yet incompletely understood. 5-7 Biases in public health medicine have been well recognised. The senior resident sends you to the medical ward to quickly discharge a 67-year- old patient admitted the day before with COPD.

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