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Blinding or information control in diagnosis: could it reduce errors in clinical decision-making?

  • Joseph J. Lockhart EMAIL logo and Saty Satya-Murti
Published/Copyright: September 19, 2018
Diagnosis
From the journal Diagnosis Volume 5 Issue 4

Abstract

Background

Clinical medicine has long recognized the potential for cognitive bias in the development of new treatments, and in response developed a tradition of blinding both clinicians and patients to address this specific concern. Although cognitive biases have been shown to exist which impact the accuracy of clinical diagnosis, blinding the diagnostician to potentially misleading information has received little attention as a possible solution. Recently, within the forensic sciences, the control of contextual information (i.e. information apart from the objective test results) has been studied as a technique to reduce errors. We consider the applicability of this technique to clinical medicine.

Content

This article briefly describes the empirical research examining cognitive biases arising from context which impact clinical diagnosis. We then review the recent awakening of forensic sciences to the serious effects of misleading information. Comparing the approaches, we discuss whether blinding to contextual information might (and in what circumstances) reduce clinical errors.

Summary and outlook

Substantial research indicates contextual information plays a significant role in diagnostic error and conclusions across several medical specialties. The forensic sciences may provide a useful model for the control of potentially misleading information in diagnosis. A conceptual analog of the forensic blinding process (the “agnostic” first reading) may be applicable to diagnostic investigations such as imaging, microscopic tissue examinations and waveform recognition. An “agnostic” approach, where the first reading occurs with minimal clinical referral information, but is followed by incorporation of the clinical history and reinterpretation, has the potential to reduce errors.

Keywords: blinding; cognitive bias; diagnostic error; forensic medicine; forensic psychology
Corresponding author: Joseph J. Lockhart, PhD, ABPP, Consulting Psychologist, Forensic Services Division, Department of State Hospitals, State of California, Suite 410, Sacramento, CA 95814, USA, Phone: +916-616-1465

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2018-05-26
Accepted: 2018-08-21
Published Online: 2018-09-19
Published in Print: 2018-11-27

©2018 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Learning from tragedy – improving diagnosis through case reviews
  4. Diagnostic test accuracy: a valuable tool for promoting quality and patient safety
  5. Review
  6. Blinding or information control in diagnosis: could it reduce errors in clinical decision-making?
  7. Opinion Paper
  8. System-related and cognitive errors in laboratory medicine
  9. Original Articles
  10. The Assessment of Reasoning Tool (ART): structuring the conversation between teachers and learners
  11. Determining qualitative effect size ratings using a likelihood ratio scatter matrix in diagnostic test accuracy systematic reviews
  12. Patient groups, clinicians and healthcare professionals agree – all test results need to be seen, understood and followed up
  13. Teaching about diagnostic errors through virtual patient cases: a pilot exploration
  14. Using computerized virtual cases to explore diagnostic error in practicing physicians
  15. “Closing the loop”: a mixed-methods study about resident learning from outcome feedback after patient handoffs
  16. Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty
  17. Letters to the Editor
  18. Capturing diagnostic errors in incident reporting systems: value of a specific “DX Tile” for diagnosis-related concerns
  19. PSA-based, prostate cancer risk on-line calculators: no such thing as a crystal ball?
  20. Learning from Error
  21. Learning from tragedy: the Julia Berg story
  22. Acknowledgment
  23. Congress Abstracts
  24. Diagnostic Error in Medicine
https://doi.org/10.1515/dx-2018-0030
Keywords for this article
blinding; cognitive bias; diagnostic error; forensic medicine; forensic psychology

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Learning from tragedy – improving diagnosis through case reviews
  4. Diagnostic test accuracy: a valuable tool for promoting quality and patient safety
  5. Review
  6. Blinding or information control in diagnosis: could it reduce errors in clinical decision-making?
  7. Opinion Paper
  8. System-related and cognitive errors in laboratory medicine
  9. Original Articles
  10. The Assessment of Reasoning Tool (ART): structuring the conversation between teachers and learners
  11. Determining qualitative effect size ratings using a likelihood ratio scatter matrix in diagnostic test accuracy systematic reviews
  12. Patient groups, clinicians and healthcare professionals agree – all test results need to be seen, understood and followed up
  13. Teaching about diagnostic errors through virtual patient cases: a pilot exploration
  14. Using computerized virtual cases to explore diagnostic error in practicing physicians
  15. “Closing the loop”: a mixed-methods study about resident learning from outcome feedback after patient handoffs
  16. Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty
  17. Letters to the Editor
  18. Capturing diagnostic errors in incident reporting systems: value of a specific “DX Tile” for diagnosis-related concerns
  19. PSA-based, prostate cancer risk on-line calculators: no such thing as a crystal ball?
  20. Learning from Error
  21. Learning from tragedy: the Julia Berg story
  22. Acknowledgment
  23. Congress Abstracts
  24. Diagnostic Error in Medicine
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