How Can We Prevent Misdiagnosis in Medicine?

Peter Simons
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In a new study, published in Perspectives on Medical Education, researchers attempted to create a workshop to reduce the risk of bias in diagnostic practices. The authors found that unless biases are explicitly examined, providers are likely to continue misdiagnosing patients based on assumptions, even after finding that a mistaken diagnosis led to the death of a patient.

“In order to realize the importance of bias, GPs [general practitioner doctors] have to experience the consequences for themselves,” write the researchers, led by Kaylee van Geene, a cognitive psychologist and data analyst.

Telling students about the existence of biases and teaching facts is not effective in learning to recognize situations in which bias may influence decisions. What is needed is to experience the encounter of errors as a result of bias, in a setting where students can make mistakes without serious consequences.”

Photo credit: Wikipedia commons
Photo credit: Wikipedia commons

Cognitive biases are the unconscious assumptions that we make about another person based on a number of factors—their appearance, the way they talk, or if they remind us of someone else. In many cases, these biases can appear in the form of subtle judgments about race, class, gender, sexual orientation, and disability. These judgments can impact the way practitioners go about the practice of diagnosing medical and psychiatric illness. In fact, a recent study in BMJ found that medical error is the third leading cause of death in the United States, after heart disease and cancer.

Biases held by practitioners are widely recognized as factors that influence misdiagnosis, especially in the field of mental health. For instance, a recent study by sociologist Jonathan Metzl found that clients who presented with relationship difficulties were often prescribed antidepressant medication. He writes that the depression diagnosis and the prescription of medication serve as a method to reinforce heteronormative relationships and that people who express concerns about traditional male-female romantic relationships were likely to be prescribed medication even in the absence of any clinically relevant depressive symptoms.

Other studies have found that black patients were more than twice as likely to be diagnosed with schizophrenia than white patients, while white patients were far more likely to receive a diagnosis of anxiety or depression. Metzl, investigating this trend, documented one example of this phenomenon in his 2010 book, The Protest Psychosis: How Schizophrenia Became a Black Disease. He writes that the diagnosis of schizophrenia in the 1960s became a tool for restraining people of color who rebelled against the establishment.

This new study by Kaylee van Geene presents evidence that these types of biases are just as prevalent in supposedly objective medical diagnoses. In the first phase of her experiment, participants were given cases to diagnose without any instruction to consider their biases. This resulted in several cases of misdiagnosis.

In the second phase of the study, researchers revealed the consequences of that misdiagnosis: “Participants seemed quite shaken at hearing this patient had actually passed away, because the ‘real life’ doctors had made the same mistakes as they did,” writes van Geene.

Nonetheless, participants continued to misdiagnose their patients in the experiment. Only in the third phase, when participants were explicitly instructed to consider their biases throughout the diagnostic process, did rates of misdiagnosis drop.

Although this study was conducted with students who did not interact with real patients, previous research on actual patients supports the prevalence and dangers of cognitive bias in the diagnostic process. It is not clear whether this workshop process would help reduce the risk of bias in diagnosis in the real world, but research like this is the first step toward a more accurate diagnostic process with less risk of harmful or deadly outcomes due to bias.

 

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van Geene, K., de Groot, E., Erkelens, C., & Zwart, D. (2016). Raising awareness of cognitive biases during diagnostic reasoning. Perspectives on Medical Education, 5(3), 182-185. (Abstract)

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Peter Simons
MIA-UMB News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

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11 COMMENTS

  1. “How Can We Prevent Misdiagnosis in Medicine?” A good place to start would be to get rid of the DSM psychiatric “bible,” since it has already been confessed to be both scientifically “invalid” and “unreliable.” Which, I think would technically mean every person diagnosed with a DSM disorder was misdiagnosed, since they aren’t valid diseases. And psychiatric stigmatization is known to result in basically the worst type of bias on this planet, which is why the psychiatrists have been waging marketing campaigns to supposedly reduce stigma.

    As to, “black patients were more than twice as likely to be diagnosed with schizophrenia than white patients.” I went to a “black” church last Sunday, because I work with some of the people who go to that church. And I was heartbroken to see so many people at that church, one person in particular, who suffered from really horrendous tardive dyskinesia. I can’t imagine how high a dose of antipsychotics he must be on, and he didn’t seem to be able to talk.

    What do you do? I work with the pastors of that church, so I guess I’ll try to educate them a little more about the harms of psychiatry, and maybe suggest that someone who can actually speak try to function as a advocate for him? I don’t understand how the psychiatrists can continue to medicate a person who is so obviously suffering from that long known about antipsychotic side effect.

    This is a form of egregious racism, since in reality the psychiatrists are torturing these people. And as to, “the diagnosis of schizophrenia in the 1960s became a tool for restraining people of color who rebelled against the establishment.” I thought we learned from the Russian dissidents in the 1970’s that no governments should not be using the antipsychotics on political dissidents.

      • It’s a well known fact that angry young African American men in the 1970’s had huge targets on their backs that led them to diagnoses of paranoid schizophrenia. They were locked up right and left in psychiatric “hospitals”, where they stayed for years. Couple this with the famous War on Drugs, which has never been successful because it was never about drugs but was a war on the African American community. It’s a well known fact that white drug pushers get much lighter sentences from the courts than African American drug pushers. And in fact, in the early 1970’s Dr. Peter Breggin had to fight twice against the government concerning a program to use psychiatric drugs on inner city children. The man responsible for the program stated that Blacks were just like monkeys, all they care about is having sex and killing one another. I watch these kinds of biases play themselves out each and every day that I am at work in a state hospital.

        And of course, all of these things took place under Richard Nixon who was always extremely paranoid and fearful of the African American community.

  2. “Participants seemed quite shaken at hearing this patient had actually passed away, because the ‘real life’ doctors had made the same mistakes as they did,” writes van Geene Nonetheless, participants continued to misdiagnose their patients in the experiment.
    What do you have to do? Is it arrogance, that they believe they are immune from making mistakes? That being `doctors’ confers some kind if `infallibility cloak’ and/or that their patients aren’t as important because they don’t know as much about the human body? Is it that they know they will be protected by the courts and their colleagues even in quite extreme cases? Have we endowed the medical profession with `miraculous’ status? I don’t know as much about my car as my mechanic does either, but I don’t accept that he can get away with `killing’ my car. As far as I’m concerned medical doctors (`doctor’ being a courtesy title in this case), are no more or less than a car mechanic, they are our servants, NOT our masters.