Diagnostic error is a significant problem, and one that affects all medical specialties. The issue lies in the unconscious cognitive biases of physicians and insufficient modulation of confidence. Perhaps the correct dose of humility could ultimately help to improve the accuracy of diagnoses.
By Jianni Wu and Eve J. Lowenstein
The causes of diagnostic error – that is, missed, incorrect or delayed diagnoses – are in part due to the faulty processing of data, combined with the effects of physicians’ own unconscious biases. Another, perhaps not mutually exclusive, cause of error is overconfident behavior. A general tendency towards this type of behavior has been preserved throughout evolution as it confers a selective evolutionary advantage – a species made up of overly hesitant organisms could, under certain critical conditions, face extinction.
In the field of medicine, overconfidence has been found to be a more common trait in novice physicians than experienced physicians. Behavioral scientists refer to this phenomenon as the beginner’s bubble, where perceived accuracy outweighs actual accuracy. Overconfident behavior can also be explained by the concept of error blindness – until proven wrong, we simply feel right. It is no wonder then that the image of the ideal physician is of one who projects confidence, skill, and assertiveness. However, overconfident behavior can be detrimental to patients – medically, psychologically and legally – when this manifests as missed, incorrect or delayed diagnoses.
On the other hand, humility – despite being difficult to achieve – remains one of the most important competencies to master and is a cornerstone of professionalism, according to a recent opinion paper published in the journal Diagnosis. At first, practicing humility may feel uncomfortable, as it evokes awareness of weaknesses and vulnerabilities. However, cultivating humility allows physicians to appreciate the limits of their abilities and understanding, and to recognize the ambiguities and surprises inherent to medicine. By doing so, it uncovers blind spots, helping to nurture a so-called intellectual humility.
Becoming more humble requires emotional balance, flexibility and resilience. It requires metacognition – thinking about our own thought processes and recognizing pitfalls – as well as normalizing doubt and being unafraid to utilize diagnostic tools. Perhaps the simple realization that we will all someday be patients, is its strongest driver, and it is our responsibility to find the correct balance of confidence and humility in patient care.
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