Effect of framing biases on closure thresholds for ruling disease in or out
| Presents with diagnosis label | I'd keyed in too quickly and then just ignored any of the sort of differential information (1) |
| When your brain immediately jumps to the obvious diagnosis its worth just having in the back of your mind what else it could be (6) | |
| Psychosocial label/behavioural | I closed it before she came in … I think hadn't really thought out the differential diagnosis (4) |
| Not appreciating the seriousness of the, of the problem, coupled with not really wanting to think about it because the patient was so difficult. (31) | |
| Ignores red flag | [did not] take a step back and consider what we call the sort of red flagged ones, are there any flags in front of you that are presenting information of other serious diseases that might kill or harm? (2) |
| Think I ought to have thought this severe pain which isn't improving I ought to go back to cancer but so I was put off by the negative investigations and that kind of prior assessment and err … level of pain which was not otherwise explained (15) | |
| Ignores possibility of serious disease with low probability | [ignored] older the patient the lower the threshold for particularly for colorectal cancer that we would have for referring … red flag that's there for a reason therefore it would be foolish to sort of dismiss (14) |
| My preconception at the time was that a young 28 year old is very, very unlikely to have bowel cancer … slightly raised C-reactive protein…it wasn't dramatically raised … I certainly didn't act on it because I think I was confused by the fact he'd got better the second consultation (32) | |
| Used wrong clinical features to rule-out a condition | [ignored] new onset quite severe headache in a (40) something year old is a red flag in itself (22) |
| We think of ectopic pregnancy as being bleeding and pain and this was painless bleeding (17) | |
| Ignored gut feelings | it's a sixth sense … that I think as you gain more experience you really hone and fine tune … it's invaluable particularly with children 19; was not terribly unwell … obviously needed more investigations … wasn't happy with my decision even though it wasn't a conscious process. (33) |