Cognitive biases of physicians can also prevent an accurate initial diagnosis or changing a diagnosis to the correct one. A first impression of a patient having psychological symptoms and ignoring further aspects of the exam could lead to confirmation bias. Failure to reevaluate for lupus a patient who was seen for fibromyalgia by a previous provider could lead to anchoring bias. These examples are just a few pitfalls that could lead physicians into misdiagnosing their patients.6
The Art of Medicine
How do we go about changing a patient’s diagnosis once we are confident that the wrong diagnosis was made without negatively influencing the physician-patient relationship? This dilemma is where the “art of medicine” comes into play. In the referenced case, the patient has adapted her life significantly to her lupus diagnosis. Therefore, establishing trust and developing a good rapport with her may take multiple visits. Allocating enough time for a discussion, evaluating current medications and reassuring the patient that you will continue to follow her in your clinic are key factors in the process.
Joseph L. Green, DO, is a second-year rheumatology fellow at the University of Tennessee Health Science Center. He is a member of the ACR Committee on Ethics and Conflicts of Interest.
Acknowledgment: I would like to thank Dr. Syed Raza for his input regarding the article.
References
- Daly R, Partovi R, Davidson P. Lupus diagnosis: Process and patient experience [abstract]. Arthritis Rheumatol. 2017;69(suppl 10).
- Barhamain AS, Magliah RF, Shaheen MH, et al. The journey of rheumatoid arthritis patients: A review of reported lag times from the onset of symptoms. Open Access Rheumatol. 2017 Jul;9:139–150.
- Code of Ethics of the American College of Rheumatology Inc. American College of Rheumatology. 2017 Aug.
- Kübler-Ross E, Kessler D. On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. New York City: Scribner, 2014.
- Okamura H, Uchitomi Y, Sasako M, et al. Guidelines for telling the truth to cancer patients. Jpn J Clin Oncol. 1998 Jan 1;28(1):1–4.
- Cognitive biases in health care. Quick Safety. 2016 Oct;28:1-3.
