The Fallacy of a Single Diagnosis

Donald A. Redelmeier and Eldar Shafir
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Donald A. Redelmeier: Department of Medicine, University of Toronto, Toronto, ON, Canada
Eldar Shafir: Department of Psychology, Princeton University, Princeton, NJ, USA

Medical Decision Making, 2023, vol. 43, issue 2, 183-190

Abstract: Background Diagnostic reasoning requires clinicians to think through complex uncertainties. We tested the possibility of a bias toward an available single diagnosis in uncertain cases. Design We developed 5 different surveys providing a succinct description of a hypothetical individual patient scenaric. Each scenario was formulated in 2 versions randomized to participants, with the versions differing only in whether an alternative diagnosis was present or absent. The 5 scenarios were designed as separate tests of robustness using diverse cases, including a cautious scenario, a risky scenario, a sophisticated scenario, a validation scenario, and a comparative scenario (each survey containing only 1 version of 1 scenario). Participants included community members ( n = 1104) and health care professionals ( n = 200) who judged the chances of COVID infection in an individual patient. Results The first scenario described a cautious patient and found a 47% reduction in the estimated odds of COVID when a flu diagnosis was present compared with absent (odds ratio = 0.53, 95% confidence interval 0.30 to 0.94, P = 0.003). The second scenario described a less cautious patient and found a 70% reduction in the estimated odds of COVID in the presence of a flu diagnosis (odds ratio = 0.30, 95% confidence interval 0.13 to 0.70, P

Keywords: clinical reasoning; premature closure; cognitive bias; diagnostic pitfall; disease comorbidity; Occam’s razor (search for similar items in EconPapers)
Date: 2023
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:43:y:2023:i:2:p:183-190

DOI: 10.1177/0272989X221121343

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