From the Guidelines
Diagnostic anchoring can be mitigated by adopting a systematic approach to diagnosis, including the use of analytical or 'System 2' thinking, which involves reviewing options and choosing the most appropriate decision, as suggested by Daniel Kahneman 1. This approach can help clinicians avoid relying on mental shortcuts or heuristics that can lead to errors. Some key strategies to avoid diagnostic anchoring include:
- Practicing metacognition, or thinking about one's own thinking, to recognize potential biases and assumptions
- Actively considering differential diagnoses and seeking disconfirming evidence
- Using structured diagnostic frameworks to guide the evaluation process
- Seeking second opinions and encouraging team members to voice alternative viewpoints
- Taking diagnostic time-outs to reassess cases and maintain awareness of one's cognitive vulnerabilities. According to the study published in the European Heart Journal 1, faulty cognition is a major cause of diagnostic errors, and by training ourselves to pause and override intuitive thinking, we can reduce the likelihood of diagnostic anchoring and improve patient outcomes. For instance, in the case of a patient with chest pain, a provider might anchor on an initial diagnosis of acid reflux, but by considering alternative explanations and seeking disconfirming evidence, they may uncover signs of cardiac disease, ultimately improving patient safety and reducing the risk of misdiagnosis. By adopting these strategies, clinicians can reduce the impact of diagnostic anchoring and provide more accurate and comprehensive diagnoses, as highlighted in the study 1.
From the Research
Diagnostic Anchoring
- Diagnostic anchoring refers to the tendency of clinicians to rely too heavily on initial information or diagnoses, potentially leading to errors or delays in diagnosis 2, 3.
- This cognitive bias can result in clinicians being less likely to consider alternative diagnoses or test for other conditions, even when presented with new or contradictory information 2.
- Studies have shown that diagnostic anchoring can lead to delayed workup and diagnosis of conditions such as pulmonary embolism (PE) in patients with congestive heart failure (CHF) 2.
- The anchoring effect is one of several cognitive biases that can affect clinicians' decision-making, including overconfidence, information and availability biases, and tolerance to risk 3.
- Addressing cognitive errors such as diagnostic anchoring is crucial to improving patient care, particularly in high-pressure environments like emergency departments 4.
Factors Contributing to Diagnostic Anchoring
- Organizational and communication factors, such as the way patient information is presented and documented, can contribute to diagnostic anchoring 5, 2.
- Individual clinician factors, including experience and training, can also play a role in the development of diagnostic anchoring 3.
- Patient factors, such as the presence of comorbidities or complex medical histories, can increase the risk of diagnostic anchoring 5.
Implications for Patient Care
- Diagnostic anchoring can have significant implications for patient care, including delayed or missed diagnoses, inappropriate treatment, and poor patient outcomes 2, 3.
- Strategies to mitigate diagnostic anchoring, such as encouraging clinicians to consider alternative diagnoses and using decision-support tools, are essential to improving patient care 4.