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A piece of research published in the Medical Journal of Australia looked at whether bias in clinical history affects the accuracy interpreting ECGs, in doctors working in emergency departments.
The results found that “doctors were more accurate when provided with history suggestive of the correct ECG diagnosis. The history may have directed participants to search for specific ECG findings or alerted them to possible diagnoses that they might not have otherwise considered. Clinicians may have also combined history with ECG findings to make their ECG diagnoses, rather than interpreting ECGs independently.13 This suggests that ECG interpretation may not be independent of the pre-test probability, contrary to the traditional Bayesian approach to clinical reasoning.”
However, if the clinical history suggested an alternative diagnosis to the doctor’s initial diagnosis – this had a detrimental effect on diagnostic accuracy. “Cognitive processes such as anchoring bias, confirmation bias and premature closure may have contributed to participants ignoring findings consistent with the correct ECG diagnoses. This is consistent with results of research which show that diagnostic suggestion can lead to interpretation errors, particularly in the context of atypical or inconsistent clinical histories.14-16 Clinicians therefore need to ensure that any history obtained before the interpretation of ECGs is reliable and accurate. Furthermore, strategies are required so that an incorrect or atypical history does not adversely affect the interpretation of diagnostic test results.”
How do you think clinical history influences your interpretation of ECGs? How do you cognitively approach them?