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TJC Urges Caution About Cognitive Biases in Diagnostics

By Jonathan Springston, Editor, Relias Media

The Joint Commission (TJC) has issued an alert urging clinicians to remain aware of possible cognitive biases that could lead to misdiagnoses and poor patient outcomes.

“Diagnostic overshadowing” occurs when a clinician attributes symptoms to an existing diagnosis rather than a possible co-morbid condition. This can lead to the clinician missing the real diagnosis that is causing the patient’s presenting complaints. TJC indicates this is especially a problem for communities already likely to experience disparities in healthcare (e.g., LGBTQ+ patients, those living with mental illness, and people managing substance abuse issues).

“Diagnostic overshadowing is a serious safety and quality concern as an initial misdiagnosis can have a significant impact on quality of life, including the physical and psychological wellness of patients,” said Ana Pujols McKee, MD, TJC’s executive vice president; chief medical officer; and chief diversity, equity, and inclusion officer. “I urge my physician colleagues to recognize that diagnostic overshadowing stems from cognitive bias and work to reduce this through training and education programs. Such bias can have a detrimental effect on future patient workups and how handoffs to other providers are framed.”

Diagnostic overshadowing will be a key topic in the upcoming September issue of ED Management. Author Dorothy Brooks will interview a biomedical researcher who has delved into the dangers of diagnostic overshadowing. She will report on specific instances when patients with disabilities presented to the ED with classic symptoms of cancer or other issues, but were repeatedly sent home with the wrong diagnosis. In those cases, providers were certain, even without testing, the patients’ issues stemmed from their disabilities.

Brooks also will interview a safety program director who will discuss how challenging it is to identify whether diagnostic overshadowing is a problem in a particular work setting. Additionally, he will offer advice on how EDs can take steps toward improvement in this area through awareness efforts and other interventions.

Meanwhile, author Stacey Kusterbeck will examine the legal exposure if emergency providers overlook medical emergencies in psychiatric patients. What are some scenarios in which emergency providers might assume a patient’s symptoms are caused by their psychiatric complaint and miss a medical emergency? In those cases, what documentation becomes important? What factors hurt the provider’s defense? To learn more, be sure to check out the entire issue when it is released later this month.