Mr. Smith is a 70-year old man who was admitted from the emergency department with nausea and vomiting after receiving chemotherapy two days earlier. At the time of admission, he was diagnosed with dehydration and acute kidney injury. Over the next 3 days, his condition worsened. The diagnosis was then changed to sepsis with multiple organ failure about 72 hours after admission. Antibiotics were not started in a timely manner. One week later, Mr. Smith passes away.
When the hospital team reviews the charts, they believe that the diagnosis of sepsis and initiation of antibiotics could have been considered earlier in the hospital course.
The mistake that occurred here is a diagnostic error called anchoring bias. Anchoring bias, also known as premature closure, is defined by the Agency for Healthcare Research and Quality as relying on an initial diagnostic impression despite subsequent information to the contrary.
Anchoring bias is the most common single cause of diagnostic errors. In the case of Mr. Smith, once the diagnosis of dehydration and acute kidney injury were made, the doctors became “anchored” to that diagnosis and did not consider other possibilities until much later. In this case, when it was too late.
Anchoring bias happens every day in hospitals all over the world. And lives are lost because of it.
An anchoring bias that is much worse
It’s hard to imagine anything that is much worse than making the mistake of anchoring to a diagnosis and missing a disease that leads to someone’s death. While that is something awful, I think what is much worse is that many people live day in day out for decades wasting their lives by anchoring to scripts and paradigms that are no longer true for them.
Maybe years ago, in one brief season of your life, you didn’t do the right things and so failed in several endeavors. But it’s been years now and you have grown and learned a lot and that initial diagnosis is no longer true. There have been decades of subsequent information to the contrary but you still anchor to that wrong diagnosis. You are the doctor who is making the anchoring bias that will eventually lead to the death, not only your life but of your dreams, your calling, and the impact you were supposed to make in this world.
Passing away, as horrible as it is, is the death of the physical body. We kill the life itself that we’ve been given when we continue to anchor to the wrong diagnosis instead of considering the new evidence that is coming up every day and choosing to embrace who we are so that we can substantiate what is already within us and blossom into that mighty oak that blesses all around us.
References
https://psnet.ahrq.gov/primers/primer/12/diagnostic-errors Last Accessed March 2018
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