JAMA: Reflective reasoning hones diagnostic accuracy
When diagnosing clinical cases, “availability bias” can occur in response to recent experiences with similar clinical cases, producing diagnostic errors. However, reflective reasoning may help counteract this bias, according to a study that appeared online Sept. 14 in the Journal of the American Medical Asssociation.

Silvia Mamede, MD, PhD, of Erasmus University Rotterdam, the Netherlands, and colleagues studied whether recent experience with clinical problems provokes availability bias—overestimation of the likelihood of a diagnosis based on the ease with which it comes to mind.

“The results suggest that the occurrence and negative effects of availability bias are a function of the reasoning approach and the expertise level,” the authors wrote. “Encountering only one case of a disease was sufficient to make second-year residents more prone to incorrectly giving that diagnosis to subsequent cases of different, though similar, diseases,” the article states.

Because reliance on non-analytical reasoning tends to increase with experience, physicians with years of clinical practice may be even more susceptible to availability bias than second-year residents. In addition, experienced clinicians appear to be less likely to spontaneously overrule an incorrect initial diagnosis, according to the study.

“Although reliance on non-analytical reasoning [works] well in many situations, reducing the time and effort involved in decision making and allowing physicians to make accurate diagnoses in routine situations, it may open the door to cognitive bias. Reflection has been shown to improve diagnosis when problems are complex or non-routine, and this study indicates that reflection may also be a mechanism to counteract cognitive biases,” the authors stated.

The study suggests that a relatively simple instructional procedure can be used to induce reflective reasoning and improve diagnostic accuracy, according to the authors, and a procedure for reflective reasoning can be implemented relatively easily in educational situations. “Further research should investigate the effects of this process on diagnostic reasoning in practice settings,” they stated.

“The study provides further evidence that flaws in reasoning processes rather than knowledge gaps may underlie diagnostic errors and showed the potential for repair by reflective reasoning,” the authors concluded.