Question

Directions: Read carefully the medical errors set forth below as explained in the book. Define the error and then provide a business example that would be descriptive of this type of error. "How doctors think."

1. Bandwagon Effect
2. Anchoring
3. Diagnosis Momentum
4. Representative error.
5. Attribution error
6. Affective error
7. Availability errors
8. Confirmation bias
9. The Ying-Yang Out Mistake
10. Gatekeeper Issues that lead to errors
11. Overworked issues that lead to errors
12. Errors due to sheer volume
13. Miscommunication errors.
14. Zebra Retreat
15. Overconfident mindset
16. Natural human variation issues
17. Commission error
18.   Satisfaction of search error
19. Vertical line error
20.    “Last Bad Experience” error

Answer 1

1. Bandwagon Effect

Answer:

The bandwagon effect is a psychological phenomenon in which people do something primarily because other people are doing it, regardless of their own beliefs, which they may ignore or override. This tendency of people to align their beliefs and behaviors with those of a group is also called a herd mentality.

Medical bandwagons have been identified as "the overwhelming acceptance of unproved but popular ideas". They have led to inappropriate therapies for numerous patients, and have impeded the development of more appropriate treatment.

examples of the Bandwagon Effect:

• Diets: When it seems like everyone is adopting a certain fad diet, people become more likely to try the diet themselves.
• Fashion: Many people begin wearing a certain style of clothing as they see others adopt the same fashions.

2. Anchoring

Prematurely settling on a single diagnosis based on a few important features of the initial presentation and failing to adjust as new information become available. This is closely related to, and made worse by, confirmation bias.

Anchoring bias occurs when people rely too much on pre-existing information or the first information they find when making decisions.

For example, if you first see a T-shirt that costs $1,200 – then see a second one that costs $100 – you're prone to see the second shirt as cheap.

3. Diagnosis Momentum

Accepting a previous diagnosis without sufficient scepticism. Continuing a clinical course of action instigated by previous clinicians without considering the information available and changing the plan if required (particularly if plan commenced by more senior clinician)

A form of diagnosis momentum – the triage nurse diagnosed the patient as “not sick”, therefore the patient must not be sick

Fixating on a previously assigned label of ‘possible pulmonary embolism’ and organising CT imaging for a patient who may have subsequent results that suggest otherwise (e.g. positive blood cultures the following day)

4. Representative error.

Misinterpreting the likelihood of an event considering both the key similarities to its parent population, and the individual characteristics that defi ne that event

A man with classic symptoms of a heart attack, but also anxious, and who’s breath smelled of alcohol. The latter details have no bearing on the likelihood of a heart attack, nor alter the degree to which he is a member of his risk demographic but distract and decrease the diagnostic pick up

5. Attribution error

The third major thinking trap is an “attribution error.” This occurs when a physician is overly influenced by certain personal characteristics, particularly those that correspond to social stereotypes. The doctor then fits the history, physical findings and laboratory studies into a preset conception about that person, rather than weighing the information in a dispassionate way.

example, in one study when something bad happened to someone else, subjects blamed that person's behavior or personality 65% of the time.

6. Affective error

Affective error (aka outcome bias, value bias, the chagrin factor) This is the tendency to convince yourself that what you want to be true is true, instead of less appealing alternatives.

An affective error occurs when clinicians allow their personal feelings towards patients, called countertransference in psychiatric parlance, to affect their care. Clinicians are human, and they will naturally like some patients and dislike others. As such, countertransference is normal and unavoidable.

Example:if you see a friend with a headache, you are more likely to opt for a benign diagnosis than subject them to a lumbar puncture to rule out subarachnoid hemorrhage. Similarly, when we dislike a patient, we may write off her shortness of breath as anxiety instead of considering pulmonary embolism. Countertransference is a subset of affective error.

7. Availability errors

More recent and readily available answers and solutions are preferentially favoured because of ease of recall and incorrectly perceived importance

Example Recent missed pulmonary embolism prompts excessive CT pulmonary angiogram scanning in lowrisk patients

8. Confirmation bias

Diagnosticians tend to interpret the information gained during a consultation to fi t their preconceived diagnosis, rather than the converse

Example Suspecting the patient has an infection and the raised white cells proves this, rather than ‘I wonder why the white cells are raised, what other findings are there?’

9. The Ying-Yang Out Mistake

The yin-yang out is the tendency to believe that nothing further can be done to throw light on the dark place where, and if, any definitive diagnosis resides for the patient, i.e. the physician is let out of further diagnostic effort.

So far, light, day, and sun are on the yang side of our list. Some other examples of things that are considered yang include heat, summer, movement (e.g. running), awake, and masculinity. Their opposites (cold, winter, rest, sleep, and femininity) are considered yin.

yin things tend to be dark, still, and about resting or nourishing, while yang things tend to be more about light, movement, and activity.

10. Gatekeeper Issues that lead to errors

A gatekeeper's duty primarily is to manage a patient's treatment. ... When a patient falls ill or needs to be referred to a specialist, the patient contacts the gatekeeper, who in turn refers the patient to doctors and specialists within the plan network.

Gatekeeper.

Eg. primary care physician or insurance company to approve all patient referrals and non emergency services. Primary care physician (PCP) acts in a gatekeeper capacity, because he or she is responsible for the patient's medical care and any referrals.

11. Overworked issues that lead to errors

Overwork is the expression used to define the cause of working too hard, too much, or too long.having to work beyond their capacity or strength.Fatigue leads to a host of emotional, cognitive, and physical problems. Overworked nurses may suffer from an inability to focus, irritability, impaired decision-making, headaches, drowsiness, confusion, and depression. These symptoms may lead to harmful mistakes such as: Administering the wrong medication

12. Errors due to sheer volume

We have the ability to build technologies into the physical spaces where health care is delivered to help cut the rate of fatal errors that occur today due to the sheer volume of patients and the complexity of their care.

The sheer volume of medical data that is associated with each patient in today’s healthcare systems is staggering and increases each time a patient sees a doctor, undergoes tests, or is admitted to the hospital. Being able to manage and access that data in real-time to deliver more accurate diagnoses and avoid contraindicated treatments is critical.

13. Miscommunication errors.

A lapse in communication or failure to relay crucial information may lead to a serious medical error, injury or even death.They found that approximately 80 percent of medical mistakes are caused by health care miscommunication.

Example: When you leave a message for someone and it doesn't get recorded properly, this is an example of a miscommunication. An interaction between two parties in which information was not communicated as desired.

14. Zebra Retreat

Zebra retreat is where a rare diagnosis figures prominently in the differential diagnosis list, but the doctor is reluctant to, or retreats from, making the diagnosis. This can result in a delayed diagnosis or more importantly, missing a diagnosis not to be missed that requires urgent attention. The zebra retreat bias is on a spectrum with availability bias (tendency to diagnose based on examples that easily come to mind) and base rate neglect (failure to factor disease prevalence into diagnostic reasoning).

If we are not finding any zebras, we may be over-influenced by availability bias, however if we are finding too many zebras, it’s likely that we are neglecting the prevalence of the disease (resulting in poor use of resources and overdiagnosis).

Example:A patient presents with a sudden, severe headache and vomiting following a banquet. The patient believes this is due to food poisoning.

15. Overconfident mindset

Excessively or unjustifiably confident, having too much confidence (as in one's abilities or judgment) an overconfident driver wasn't overconfident about their chances of winning.

Example : New surgeon or medical student trying to perform a procedure alone without any seniors supervision which he is not sure about.

16. Natural human variation issues

Human variation, is the range of possible values for any characteristic, physical or mental, of human beings.

Human factors are always a problem, and identifying errors permits improvement strategies to be undertaken. For example, the healthcare worker may have different ideas about a problem under the influence of human variation.

1. Commission error

A tendency towards action rather than inaction. The bias is ‘ommision bias’

Example Historical transfusion targets in gastrointestinal bleeds – the approach was traditionally to aim for higher targets rather than do nothing. ‘Better to be safe than sorry’ and to raise the haemoglobin ‘just in case’

1.   Satisfaction of search error

Satisfaction of search (SOS) error is a common error in diagnostic radiology. It occurs when the reporting radiologist fails to continue to search for subsequent abnormalities after identifying an initial one.

1. Vertical line error

Medication Error Reporting and such events may be related to professional practice, health care products etc and the hospital, and this error reached the patient, bypassing all lines of defense meant to prevent errors.. The two solid vertical lines separate the three tiers of priority.

1.    “Last Bad Experience” error

People who have had that sort of bad experience in any medical care or treatment or during a health assessment etc.

Example: Pain and anxiety during a procedure due to sister not maintaining proper pain management and not maintaining privacy.