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teaching:cognitive-bias-misdiagnosis-overdiagnosis [on May 31, 2020]
teaching:cognitive-bias-misdiagnosis-overdiagnosis [on February 14, 2022] (current)
psychdb [Anchoring Bias]
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-====== Cognitive Biases, Misdiagnosis,​ and Overdiagnosis ======+====== Cognitive Biases, Misdiagnosis, Iatrogenesis, and Overdiagnosis ======
 {{INLINETOC}} {{INLINETOC}}
 ===== Primer ===== ===== Primer =====
-**Cognitive Bias, Misdiagnosis,​ Diagnostic Overshadowing,​ Iatrogenic Diagnosis, and Overdiagnosis** are important clinical issues to be aware about. 
- 
 <WRAP group> <WRAP group>
 <WRAP half column> <WRAP half column>
-<​callout>​ +**Cognitive BiasMisdiagnosisDiagnostic Overshadowing,​ Iatrogenic Diagnosis, and Overdiagnosis** are important clinical issues ​to be aware about in medicineThis is especially important in psychiatry, since there are few objective clinical tests for most disorders, and relies on the subjectivity of both patient report and interpretation of these symptoms by clinicians.
-//"I suppose it is temptingif the only tool you have is a hammer, to treat everything as if it were a nail.+
-//​[([[https://​www.psychologytoday.com/​blog/​you-are-not-so-smart/​201203/​maslows-hammer|Psychology Today: Maslow’s Hammer]])] +
--- Abraham Maslow +
-</​callout>​ +
- +
-<​callout>//"​Clinical experience. Making ​the same mistakes with increasing confidence."//</​callout>​ +
 </​WRAP>​ </​WRAP>​
-<WRAP half column> 
  
 +<WRAP half column>
 +<​callout>​
 +//"I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail."//​
 +\\ \\
 +-- Abraham Maslow[([[https://​www.psychologytoday.com/​blog/​you-are-not-so-smart/​201203/​maslows-hammer|Psychology Today: Maslow’s Hammer]])]
 +</​callout>​
 +<​callout>​
 +//"We offer what we have, not what we should."//​
 +\\ \\
 +-- Anonymous
 +</​callout>​
 +<​callout>​
 +//"​Clinical experience. Making the same mistakes with increasing confidence."//​
 +\\ \\
 +-- A Skeptic'​s Medical Dictionary
 +</​callout>​
 <​callout>​ <​callout>​
 //"The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubts."//​ //"The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubts."//​
 +\\ \\
 -- Bertrand Russell -- Bertrand Russell
 </​callout>​ </​callout>​
- 
 </​WRAP>​ </​WRAP>​
 </​WRAP>​ </​WRAP>​
- 
 ===== Cognitive Biases ===== ===== Cognitive Biases =====
  
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   * [[https://​www.cmpa-acpm.ca/​serve/​docs/​ela/​goodpracticesguide/​pages/​human_factors/​Cognitive_biases/​pdf/​hf_common_cognitive_biases-e.pdf|CMPA Good Practices Guide: Cognitive Biases]]   * [[https://​www.cmpa-acpm.ca/​serve/​docs/​ela/​goodpracticesguide/​pages/​human_factors/​Cognitive_biases/​pdf/​hf_common_cognitive_biases-e.pdf|CMPA Good Practices Guide: Cognitive Biases]]
   * [[http://​qualitysafety.bmj.com/​content/​22/​Suppl_2/​ii58|Croskerry P, Singhal G, Mamede S. Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ Qual Saf 2013;​22:​ii58-ii64.]]   * [[http://​qualitysafety.bmj.com/​content/​22/​Suppl_2/​ii58|Croskerry P, Singhal G, Mamede S. Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ Qual Saf 2013;​22:​ii58-ii64.]]
-  * [[https://​www.theatlantic.com/​health/​archive/​2017/​02/​when-evidence-says-no-but-doctors-say-yes/​517368/​|The Atlantic: When Evidence Says No, but Doctors Say Yes]] +==== Anchoring Bias ==== 
-  * [[https://pubmed.ncbi.nlm.nih.gov/​30885967/|JatoiI., & SahS. (2019). Clinical practice guidelines and the overuse ​of health care services: need for reformCMAJ191(11), E297-E298.]]+  * [[https://www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC1495355/|GraberM. A., Bergus, G., Dawson, J. D., Wood, G. B., Levy, B. T., & LevinI. (2000). Effect ​of a patient'​s psychiatric history on physicians'​ estimation of probability of diseaseJournal of general internal medicine15(3), 204-206.]] 
 +  * [[https://​www.mrt.com/​news/​article/​She-was-headed-to-a-locked-psych-ward-Then-an-ER-16913004.php|MRT:​ She was headed to a locked psych ward. Then an ER doctor made a startling discovery.]]
  
 ==== Dunning-Kruger Effect ==== ==== Dunning-Kruger Effect ====
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 <callout type="​info"​ title="​Gender Bias in the Diagnosis of Borderline Personality Disorder"​ icon="​true">​ <callout type="​info"​ title="​Gender Bias in the Diagnosis of Borderline Personality Disorder"​ icon="​true">​
-Robust research studies suggest that prevalence of borderline personality disorder may actually equal between males and females, yet in clinical settings and according to the DSM, females are diagnosed with a ratio of 3:1 compared to men.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​18426259/​|Grant,​ B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., ... & Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry, 69(4), 533.]])] Clinician bias in diagnosis and sampling bias are both thought to be causes for this difference. For example, men may possibly be diagnosed with antisocial personality disorder over borderline personality disorder because of co-occuring substance use[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3115767/​|Sansone,​ R. A., & Sansone, L. A. (2011). Gender patterns in borderline personality disorder. Innovations in clinical neuroscience,​ 8(5), 16.]])]+Robust research studies suggest that prevalence of borderline personality disorder may actually ​be equal between males and females, yet in clinical settings and according to the DSM, females are diagnosed with a ratio of 3:1 compared to men.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​18426259/​|Grant,​ B. F., Chou, S. P., Goldstein, R. B., Huang, B., Stinson, F. S., Saha, T. D., ... & Ruan, W. J. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry, 69(4), 533.]])] Clinician bias in diagnosis and sampling bias are both thought to be causes for this difference. For example, men may possibly be diagnosed with antisocial personality disorder over borderline personality disorder because of co-occuring substance use.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3115767/​|Sansone,​ R. A., & Sansone, L. A. (2011). Gender patterns in borderline personality disorder. Innovations in clinical neuroscience,​ 8(5), 16.]])]
 </​callout>​ </​callout>​
 ==== Attrition Bias ==== ==== Attrition Bias ====
   * [[https://​www.cmpa-acpm.ca/​en/​advice-publications/​browse-articles/​2019/​what-happened-to-the-physical-exam|CMPA:​ What happened to the physical exam?]]   * [[https://​www.cmpa-acpm.ca/​en/​advice-publications/​browse-articles/​2019/​what-happened-to-the-physical-exam|CMPA:​ What happened to the physical exam?]]
 +
 +==== Other Biases ====
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​32074429/​|Olenski,​ A. R., Zimerman, A., Coussens, S., & Jena, A. B. (2020). Behavioral heuristics in coronary-artery bypass graft surgery. New England Journal of Medicine, 382(8), 778-779.]]
 +==== Case Reports ====
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​31474126/​|Braus,​ B. R., Rummans, T. A., Lapid, M. I., Morgan, R. J., Sampson, S. M., Handler, E. M., & Dimsdale, J. E. (2019). Clinicians and Cognitive Bias: A Case of Frontotemporal Dementia Misdiagnosed as Conversion Disorder. American Journal of Psychiatry, 176(9), 690-693.]]
 +  * [[https://​www.cbc.ca/​news/​world/​hawaii-mistaken-identity-1.6129737|CBC News: He was locked up and drugged in hospital for 2 years. Police got the wrong guy]]
 ===== Misdiagnosis ===== ===== Misdiagnosis =====
   * [[http://​www.kevinmd.com/​blog/​2011/​03/​diagnostic-errors-role-patient-safety.html|Diagnostic errors and their role in patient safety]]   * [[http://​www.kevinmd.com/​blog/​2011/​03/​diagnostic-errors-role-patient-safety.html|Diagnostic errors and their role in patient safety]]
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​27585833/​|Bhat,​ R. S., & Rockwood, K. (2016). The role of diagnosis in delirium. International Psychogeriatrics,​ 28(10), 1579-1586.]]
  
 ==== Premature Closure ==== ==== Premature Closure ====
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   * [[https://​www.theguardian.com/​science/​2013/​aug/​04/​truly-madly-deeply-delusional|The Guardian: You needn'​t be wrong to be called delusional]]   * [[https://​www.theguardian.com/​science/​2013/​aug/​04/​truly-madly-deeply-delusional|The Guardian: You needn'​t be wrong to be called delusional]]
  
 +===== Iatrogenesis =====
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​29327445/​|Keijzers,​ G., Cullen, L., Egerton‐Warburton,​ D., & Fatovich, D. M. (2018). Don't just do something, stand there! The value and art of deliberate clinical inertia. Emergency Medicine Australasia,​ 30(2), 273-278.]]
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​31085917/​|Fava,​ G. A., & Rafanelli, C. (2019). Iatrogenic factors in psychopathology. Psychotherapy and Psychosomatics,​ 88(3), 129-140.]]
 ===== Overdiagnosis ===== ===== Overdiagnosis =====
-Overdiagnosis is not unique to psychiatry among medical specialties,​ but it is much more susceptible due to the lack of measurable biomarkers and reliance on diagnostic checklists like the DSM. +<alert type="​info"​ icon="​fa fa-book fa-lg fa-fw">​ 
-  * [[http://www.lessismoremedicine.com/|Less is More]]+See also: 
 +  * **[[https://​pubmed.ncbi.nlm.nih.gov/​31340212/​|Thombs,​ B. et al. (2019). Defining and evaluating overdiagnosis in mental health: A meta-research review. Psychotherapy and psychosomatics,​ 88(4), 193-202.]]** 
 +  * **[[https://​ebm.bmj.com/​content/​23/​1/​1|Brodersen,​ J., Schwartz, L. M., Heneghan, C., O’Sullivan,​ J. W., Aronson, J. K., & Woloshin, S. (2018). Overdiagnosis:​ what it is and what it isn’t. BMJ Evidence-Based Medicine, 23(1), 1-3.]]** 
 +</​alert>​ 
 + 
 +The term **Overdiagnosis** is inconsistently used in the literature, but is generally implied to mean diagnosis based on diagnostic criteria that include people with transient or mild symptoms not amenable to treatment.[([[https://​pubmed.ncbi.nlm.nih.gov/​31340212/​|Thombs,​ B., Turner, K. A., & Shrier, I. (2019). Defining and evaluating overdiagnosis in mental health: A meta-research review. Psychotherapy and psychosomatics,​ 88(4), 193-202.]])] ​Overdiagnosis is not unique to psychiatry among medical specialties,​ but it is much more susceptible due to the lack of measurable biomarkers and reliance on diagnostic checklists like the DSM. 
 +  * [[https://blogs.bmj.com/​bmj/​2021/​03/​30/​driven-by-good-intentions-why-widening-the-diagnostic-criteria-for-polycystic-ovary-syndrome-may-be-harming-women/|Copp, T., Doust, J., McCaffery, K., Hersch, J., & Jansen, J. (2021). Polycystic ovary syndrome: why widening the diagnostic criteria may be harming women. bmj, 373.]] 
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​22900986/​|Phelps,​ J., & Ghaemi, S. N. (2012). The mistaken claim of bipolar ‘overdiagnosis’:​ solving the false positives problem for DSM‐5/​ICD‐11. Acta Psychiatrica Scandinavica,​ 126(6), 395-401.]] 
 +  * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC3537802/​|Kudlow P. (2013). The perils of diagnostic inflation. CMAJ : Canadian Medical Association journal, 185(1), E25–E26.]] 
 +  * [[https://​pubmed.ncbi.nlm.nih.gov/​32031569/​|Doust,​ J. A., Bell, K. J., & Glasziou, P. P. (2020). Potential Consequences of Changing Disease Classifications. Jama, 323(10), 921-922.]]
   * [[https://​www.bmj.com/​content/​361/​bmj.k2035|Woloshin,​ S., & Schwartz, L. M. (2018). Overcoming overuse: the way forward is not standing still—an essay by Steven Woloshin and Lisa M Schwartz. BMJ, 361, k2035.]]   * [[https://​www.bmj.com/​content/​361/​bmj.k2035|Woloshin,​ S., & Schwartz, L. M. (2018). Overcoming overuse: the way forward is not standing still—an essay by Steven Woloshin and Lisa M Schwartz. BMJ, 361, k2035.]]
 +  * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC6818431/​|Freckelton,​ Ian QC. “Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes,​ by Paris Joel: Oxford University Press, 2015]]
   * [[http://​bjp.rcpsych.org/​content/​208/​4/​400.1|Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes]]   * [[http://​bjp.rcpsych.org/​content/​208/​4/​400.1|Overdiagnosis in Psychiatry: How Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's Misfortunes]]
-  * [[https://www.psychologytoday.com/ca/blog/dsm5-in-distress/201006/psychiatric-fads-and-overdiagnosis|FrancesAllen"​Normality is an endangered speciesPsychiatric fads and overdiagnosis." Psychiatric Times (2010).]]+  * [[https://oxfordmedicine.com/view/10.1093/med/9780199350643.001.0001/med-9780199350643|ParisJ(2020). Overdiagnosis in PsychiatryHow Modern Psychiatry Lost Its Way While Creating a Diagnosis for Almost All of Life's MisfortunesOxford University Press.]]
   * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC4917625/​|Moynihan,​ R. (2016). Caution! Diagnosis creep. Australian prescriber, 39(2), 30.]]   * [[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC4917625/​|Moynihan,​ R. (2016). Caution! Diagnosis creep. Australian prescriber, 39(2), 30.]]
   * [[http://​pediatrics.aappublications.org/​content/​134/​5/​1013|Coon,​ E. R., Quinonez, R. A., Moyer, V. A., & Schroeder, A. R. (2014). Overdiagnosis:​ how our compulsion for diagnosis may be harming children. Pediatrics, 134(5), 1013-1023.]]   * [[http://​pediatrics.aappublications.org/​content/​134/​5/​1013|Coon,​ E. R., Quinonez, R. A., Moyer, V. A., & Schroeder, A. R. (2014). Overdiagnosis:​ how our compulsion for diagnosis may be harming children. Pediatrics, 134(5), 1013-1023.]]
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   * [[https://​www.newyorker.com/​magazine/​2015/​05/​11/​overkill-atul-gawande|The New Yorker: Overkill]]   * [[https://​www.newyorker.com/​magazine/​2015/​05/​11/​overkill-atul-gawande|The New Yorker: Overkill]]
  
 +==== Fads ====
 +  * [[https://​www.psychologytoday.com/​ca/​blog/​dsm5-in-distress/​201006/​psychiatric-fads-and-overdiagnosis|Frances,​ Allen. "​Normality is an endangered species: Psychiatric fads and overdiagnosis."​ Psychiatric Times (2010).]]
 ===== Resources ===== ===== Resources =====
 +<WRAP group>
 +<WRAP half column>
 ==== For Providers ==== ==== For Providers ====
   * [[https://​www.preventingoverdiagnosis.net/​|PreventingOverdiagnosis.net]]   * [[https://​www.preventingoverdiagnosis.net/​|PreventingOverdiagnosis.net]]
 +  * [[http://​www.lessismoremedicine.com/​|Less is More]]
 +
 +</​WRAP>​
 +<WRAP half column>
 ==== Articles ==== ==== Articles ====
   * [[http://​jamanetwork.com/​journals/​jamainternalmedicine/​fullarticle/​2649266|Sinha P. Don’t Just Do Something, Stand There!. JAMA Intern Med. Published online August 21, 2017.]]   * [[http://​jamanetwork.com/​journals/​jamainternalmedicine/​fullarticle/​2649266|Sinha P. Don’t Just Do Something, Stand There!. JAMA Intern Med. Published online August 21, 2017.]]
 +
 +</​WRAP>​
 +</​WRAP>​
 +
  
 {{tag>​ax-dx}} {{tag>​ax-dx}}