Clinical reasoning in dire times. Analysis of cognitive biases in clinical cases during the COVID-19 pandemic

Coen, Matteo; Sader, Julia; Junod Perron, Noëlle Astrid; Audetat Voirol, Marie-Claude; Nendaz, Mathieu

doi:10.1007/s11739-021-02884-9

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Title		Clinical reasoning in dire times. Analysis of cognitive biases in clinical cases during the COVID-19 pandemic
Authors		Coen, Matteo Sader, Julia Junod Perron, Noëlle Astrid Audetat Voirol, Marie-Claude Nendaz, Mathieu
Published in		Internal and emergency medicine. 2022
Abstract		Cognitive biases are systematic cognitive distortions, which can affect clinical reasoning. The aim of this study was to unravel the most common cognitive biases encountered in in the peculiar context of the COVID-19 pandemic. Case study research design. Primary care. Single centre (Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland). A short survey was sent to all primary care providers (N = 169) taking care of hospitalised adult patients with COVID-19. Participants were asked to describe cases in which they felt that their clinical reasoning was “disrupted” because of the pandemic context. Seven case were sufficiently complete to be analysed. A qualitative analysis of the clinical cases was performed and a bias grid encompassing 17 well-known biases created. The clinical cases were analyzed to assess for the likelihood (highly likely, plausible, not likely) of the different biases for each case. The most common biases were: “anchoring bias”, “confirmation bias”, “availability bias”, and “cognitive dissonance”. The pandemic context is a breeding ground for the emergence of cognitive biases, which can influence clinical reasoning and lead to errors. Awareness of these cognitive mechanisms could potentially reduce biases and improve clinical reasoning. Moreover, the analysis of cognitive biases can offer an insight on the functioning of the clinical reasoning process in the midst of the pandemic crisis.
Keywords		Clinical decision-making — Cognitive dissonance — Diagnostic errors — Emergency medicine — Metacognition
Identifiers		DOI: 10.1007/s11739-021-02884-9 PMID: 34997906
Full text		Article (Published version) (696 Kb) - Free access Other version: https://link.springer.com/10.1007/s11739-021-02884-9
Structures		Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Unité de développement et de recherche en éducation médicale Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut Ethique Histoire Humanités Faculté de médecine / Section de médecine clinique / Département de santé et médecine communautaires / Institut de médecine de premier recours / Institut universitaire de médecine de famille et de l'enfance
Research groups		Acquisition de l'expertise médicale (662) Ethique et science (1008) Raisonnement clinique et contextes de soin (1018)
Project		Edmond J SAFRA foundation for clinical research in internal medicine : CGR 75976/ME-HERO
Citation (ISO format)		COEN, Matteo et al. Clinical reasoning in dire times. Analysis of cognitive biases in clinical cases during the COVID-19 pandemic. In: Internal and emergency medicine, 2022. doi: 10.1007/s11739-021-02884-9 https://archive-ouverte.unige.ch/unige:158087