As doctors we are trained to believe that facts and details will help us achieve the correct diagnosis and outcome for our patients.

What if I told you that HOW you think about a patient…your cognitive process…is the most important part of being a diagnostician?

The ability to obtain key information, zero in on the important facts, and avoid overlooking relevant data is at the heart of getting it right. Almost ALL medical mistakes center on cognitive lapses.

Let’s review six common pitfalls that can affect us all.

Six Pitfalls of Veterinary Medical Mistakes

  1. Representative Error

Thinking that is guided by a prototype; wrongly attributing clinical signs to the wrong problem.

I almost missed the diagnosis of my last atypical Addison’s disease patient, largely  because the dog was very old and male.  It is easy to get tricked into overlooking possible diagnoses or failing to consider differentials that do not fit the “profile”.

Here is another way we can be misled by a prototype…while most splenic tumors in older German Shepherds and Golden Retrievers are neoplastic, there are occasions where they are benign masses. We can council clients about the statistical likelihood of cancer in these circumstances, but we should not relay “this is cancer” without confirmatory evidence.

  1. Availability

Tendency to judge an event by the ease by which relevant examples come to mind.

Imagine what would happen if you were to walk a dog with severe lameness in front of a surgeon, a medical  oncologist, and an internist. A surgeon would think of orthopedic issues. A medical oncologist would be worried about cancer. An internist would consider polyarthritis. All are legitimate possibilities. Those that come to our mind first are influenced by what we see and do the most.

  1. Confirmation Bias

Confirming what you expect to find and ignoring or selectively accepting information; the expectation that your initial diagnosis was correct.

It is common, and mostly accurate, to diagnose pancreatitis based on clinical signs and laboratory data. But mistakes happen when we don’t reconsider our diagnosis when a patient fails to improve.  A failure to re-evaluate and reconsider our initial diagnosis can be very detrimental. A dog can have pancreatitis AND a foreign object at the same time.  A cat with IBD on a GI biopsy can also have lymphoma in another part of the intestines.

  1. Anchoring

Short cut in thinking; latching onto one possibility versus many.

Whenever I see a dog with epistaxis with normal blood work and blood pressure, I focus my hunt on the nasal passage. Most of the time that is where the problem lies, however  I have also diagnosed epistaxis secondary to systemic lymphoma and multiple myeloma. It just took me longer to find the cause because I had narrowed the hunt.

  1. Diagnosis Momentum

Failure to re-evaluate or challenge a previous diagnosis…occurs most frequently when a senior doctor or specialist has made a “diagnosis”.

Have you ever disagreed with a radiologist or pathologist but felt they had to be right instead of you? It is a mistake not to speak up and re-evaluate another doctor’s diagnosis if you have good reason.

  1. Ying-Yang

The belief that all possibilities have been evaluated; failure to re-examine or re-evaluate.

Effusion starting as a modified transudate may later reveal cancer or sepsis. An ultrasound that looks unremarkable on day one may show an obstructive pattern on day three. It is hard to explain to clients the notion of repeat testing but there is often justification for thoughtful re-evaluation.

The ability to obtain key information, zero in on the important facts, and avoid overlooking relevant data is at the heart of getting it right. We hope that by bringing awareness to these common pitfalls, you’ll consider how you think and become a better doctor.

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