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Doctors can let prejudices affect their diagnostic acumen

At a recent meeting of the American College of Physicians in Washington, D.C., a clinical educator and internist with Boston's Tufts University School of Medicine stated that a percentage of diagnostic mistakes correlated to a doctor's attitude toward a specific patient.

He bluntly remarked, "My mother-in-law hates me. She's hated me for twenty years," noting that patients who remind him of the woman present an additional challenge for him. He added that it was vital to be aware of potential "meta-cognitive error[s]" and considering how a physician's thoughts and feelings can affect a patient's prognosis.

Diagnostic reasoning is a trio of steps doctors take to arrive at the correct diagnosis for their patients. They must collect the data, see which problem is represented and correctly match up the symptoms with known diseases.

Patients can subvert the process by providing false or misleading information, and sometimes test or equipment failures can skew a physician's diagnostic perceptions.

Cognitive errors consisting of incorrectly gathered data, affective mistakes, faulty knowledge or information synthesis can all point a physician in the wrong direction when seeking a diagnosis.

But meta-cognitive errors such as attributing biases to patients with strong negative associations for the diagnosing physician can be a real danger. One solution is to refer the patients to qualified colleagues to treat.

When a physician allows prejudices toward, or preconceived notions about, certain patients to affect the normally good diagnostic judgment he or she employs, it can adversely affect the patients' outcome. If the diagnostic error is serious enough, it could potentially be life-threatening and give rise to a cause of action for malpractice litigation.

Source: Medpage Today, "How to Avoid Misdiagnosis," Shannon Firth, May 13, 2016

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