Lessons in Transport - Cognitive Biases in Critical Care Transport

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"Unfortunately, the implicit assumption in medicine is that we know how to think... but the reality is we don't"- Dr. Pat Croskerry

As critical care transport professionals we are often perceived as an action oriented specialty. We frequently pride ourselves on procedural excellence and efficiency. (a difficult intubation, or fast scene-time etc.) However, the reality is that we spend the vast majority of our patient care time engaged in cognitive behavior... in THINKING rather than acting!

Because of this, it is imperative that we make every possible effort to understand how we think while caring for others. In addition, we should be aware of some of the cognitive biases that threaten our thinking processes, decision making, and thus the patients who place their trust in us.

Cognitive Biases

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Search Satisfying: calling off the search for further abnormalities after achieving satisfaction from finding the first abnormality. Example: assuming a trauma patient's hypotension is from the large, obvious scalp laceration and then missing the coexisting tension pneumothorax

Anchoring: fixating on one piece of information when making decisions & ignoring other pertinent information.Example: assuming the reason a person is unresponsive after a MVC is because of head trauma thus ignoring the possibility of a preceding medical cause for the decreased level of consciousness. (hypoglycemia, acute MI, etc.)

Confirmation bias: tendency to look for confirming evidence to support the diagnosis we are "anchoring" to while ignoring evidence to the contrary. Example: viewing a small abrasion to the forehead as confirming evidence that the above unresponsive patient must have had head trauma

Diagnostic momentum: "following the crowd"Example: a referring hospital states that based on a patients exam and CT scan they are having an ischemic stroke. The patient receives TPA instead of the needed dextrose for their undiagnosed hypoglycemia.

Framing Effect: having your impression of the patient’s illness significantly altered based on the way in which the patient is presented to you (report from police officer, EMS crew on scene, dispatcher, outside hospital)

For more information on cognitive biases check out these other great #FOAMed links:

http://lifeinthefastlane.com/education/ccc/cognitive-dispositions-to-respond/ http://shortcoatsinem.blogspot.com/2012/08/anchors-aweigh-cognitive-bias-where-is.html