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Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths

  • Cassandra Siffert , François Romanet ORCID logo , Marion Desmazières , Priscilla Drault and Géraud Gourjon ORCID logo EMAIL logo
Published/Copyright: January 9, 2025
Diagnosis
From the journal Diagnosis Volume 12 Issue 3

Abstract

Objectives

Although cognitive biases are one of the most frequent causes of diagnostic errors, their influence remains underestimated in allied health professions, especially in osteopathy. Yet, a part of osteopathic clinical reasoning and diagnosis rely on the practitioner’s intuition and subjective haptic perceptions. The aim of this study is to highlight links between the cognitive biases perceived by the practitioner to understand cognitive patterns during osteopathic diagnosis, and to suggest debiasing strategies.

Methods

A mixed method based on an explanatory sequential type is used. (QUAN→QUAL). A quantitative cross-sectional survey of 272 French osteopaths and three focus groups including 24 osteopaths were carried out. The quantitative analysis includes multinominal logistic regression models and multiple correspondence analysis. The qualitative analysis is based on the framework method (within thematic analysis) and followed a step-by-step guide (Gale et al.).

Results

Among 19 selected biases, osteopaths feel to be affected by 9.4 ± 0.28 biases (range [1−19], median=9). Some presumed biases would be associated, and socio-demographic (gender, age) and professional (experience and types of practice) factors would modify how practitioners perceive the presence of biases. Main debiasing solutions are supervision and transcultural clinical competences.

Conclusions

Osteopaths believe their diagnosis is impaired by the presence of cognitive biases as observed in clinical reality. Some biases are shared with medical doctors, but others are more specific to osteopaths, such as confirmation bias. To reduce their effect, the practitioner needs to be aware of these cognitive patterns of clinical reasoning, understand the patient and himself better, and use objective tests.

Keywords: clinical reasoning; cognitive bias; cognitive debiasing; decision-making; diagnostic errors; osteopathic diagnosis
Corresponding author: Géraud Gourjon, PhD, Scientific and Osteopathic Research Department, Institut de Formation en Ostéopathie du Grand Avignon IFO-GA, 403 Rue Marcel Demonque, 84140, Avignon, France, E-mail:

Acknowledgments

Authors thank French osteopaths for their implications in this study.

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission. Details about author contributions following CRediT statement: CS: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Data curation, Writing – Original draft, Writing – Review & Editing, Visualization. FR: Conceptualization, Validation, Writing – Review & Editing, Supervision. PD: Investigation, Writing – Review & Editing. MD: Investigation, Writing – Review & Editing. GG: Conceptualization, Methodology, Validation, Resources, Data curation, Writing – Review & Editing, Visualization, Supervision, Project administration, Funding Acquisition.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: The raw data can be obtained on request from the corresponding author.

Appendices

Table A1:

Socioprofessional characteristics of participants.

Case Socioprofessional characteristics
Sex Age, years Time since graduation, years
A Male 64 36
B Female 27 4
C Male 48 9
D Male 54 21
E Female 40 15
F Female 38 15
G Male 52 27
H Female 32 9
I Female 25 2
J Male 27 1
K Female 25 2
L Female 37 11
N Female 26 1
O Female 42 10
P Female 28 3
Q Male 38 12
R Male 35 9
S Male 25 1
T Male 27 4
U Female 66 20
V Male 45 18
W Male 37 11
X Male 44 11
Z Female 50 21
Table A2:

Participants’ suggestions to define cognitive biases.

Category Suggestions n (%)
Who is affected Specific to human brain 30 (2.05)
Practitioner-patient 13 (0.89)
Osteopath 6 (0.41)
Subjectivity Subjective 6 (0.41)
Free will 1 (0.07)
Discrepancy between subjective and objective reality 1 (0.07)
Clear-headedness Consciousness-awareness 13 (1.09)
Overconfidence Something you think you know and don’t question 2 (0.14)
Lack of self-criticism 1 (0.07)
Partiality Information processed through our own lens 4 (0.27)
Loss of impartiality 1 (0.07)
Synonyms Erroneous/misleading/false/automatic/preconceived ideas 57 (3.90)
Errors of interpretation/thought/analysis/reasoning/judgement/interpretation 21 (1.43)
Mental shortcuts 15 (1.02)
Deceptive/misleading/erroneous/illogical cognitive patterns 15 (1.02)
Misconceptions, prejudices 9 (0.61)
Automatic thinking/improper cognitive mechanism 7 (0.48)
Mental jamming/mental projection/mental barriers 5 (0.34)
Distortions of thought/cognition/perception/judgment distortions of reality 5 (0.34)
Anticipation 1 (0.07)
Brain reflexes 1 (0.07)
Influencing factors Beliefs 33 (2.25)
Experience [professional] 13 (0.89)
Knowledge 12 (0.82)
Learning 3 (0.2)
Emotional state 3 (0.21)
Personal experience 2 (0.14)
Bias effect Influence on diagnosis/judgement/management/sensory perception/practice/global vision/decision-making/the mind 116 (8.13)
Could alter perceived information/reality/reasoning/judgment/decision-making/osteopathic care/practitioner analysis 26 (1.77)
Modify perception/information processing/decision-making/diagnosis/intrinsic thinking/involuntary information processing 24 (1.64)
Lead to a wrong decision 22 (1.50)
Distort clinical reasoning 16 (1.09)
Change information/diagnosis/cognitive processing of information/thinking/the brain/interpretations/logic 11 (0.75)
Direct the processing/perception of information 7 (0.68)
Spoil the thought process 7 (0.48)
Disrupt analysis/reality/judgment 6 (0.41)
Distort knowledge/information acquisition 4 (0.27)
Modify decision making/diagnosis 4 (0.27)
Limit objectivity/lose objectivity/hinder objectivity 3 (0.21)
Prevent other options from appearing 2 (0.14)
Influence on treatment/palpatory diagnosis 2 (0.14)
Disrupt neutrality 2 (0.14)
Affect decision making 1 (0.07)
Distort logic 1 (0.07)
Interfere with patient care 1 (0.07)
Manipulate 1 (0.07)
Cognitive errors Erroneous information processing 7 (0.48)
Impaired/inappropriate understanding 5 (0.34)
Illogical/irrational approach 2 (0.14)
Early decision making/innate neural system 2 (0.14)
Failure to put various hypotheses out to tender 1 (0.07)
Difficulty in processing information 1 (0.07)
Find dysfunction by reasoning before palpatory diagnosis 1 (0.07)
Premature interpretation 1 (0.07)

  1. n, number of times the suggestions is given.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2024-0144).

Received: 2024-08-28
Accepted: 2024-12-16
Published Online: 2025-01-09

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2024-0144
Keywords for this article
clinical reasoning; cognitive bias; cognitive debiasing; decision-making; diagnostic errors; osteopathic diagnosis

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis
  4. Prenatal screening for genetic disorders: updated guidelines, proposed counseling, a holistic approach for primary health care providers in developing countries
  5. A scoping review of fever of unknown origin with normal serum C-reactive protein
  6. Mini Review
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  8. Opinion Papers
  9. Demystifying cognitive bias in the diagnostic process for frontline clinicians and educators; new words for old ideas
  10. Physicians’ prism: illuminating history with structured expertise
  11. Original Articles
  12. Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
  13. A synthesized differential diagnosis is associated with fewer diagnostic errors compared to an inventorial list
  14. Equity-Driven Diagnostic Excellence framework: An upstream approach to minimize risk of diagnostic inequity
  15. Two decades of autopsy-detected diagnostic errors in Japan
  16. Does management reasoning display context specificity? An exploration of sleep loss and other distracting situational (contextual) factors in clinical reasoning
  17. Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths
  18. Racial and ethnic disparities in pediatric emergency department patients with missed opportunities for diagnostic excellence
  19. Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
  20. “Innumerable” lesion burden on brain MRI ‒ a diagnostic approach
  21. Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis
  22. Exploring emergency department providers’ uncertainty in neurological clinical reasoning
  23. Analytical performance and user-friendliness of four point-of-care measuring systems for monitoring prothrombin time international normalized ratio in the hands of the intended users
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  30. Letters to the Editor
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