Is Bias Limiting Your Effectiveness as a Prehospital Provider?

The Ditch Doc EM Podcast: Episode 8



Show Notes


What is Bias?

Merriam Webster defines bias as: an inclination of temperament or outlook; especially a personal and sometimes unreasoned judgment

How Can Bias Affect Providers?


Misinterpretation of Research

    • Searching for studies that support your belief.
      • Biased Ex 1: Dangers of Ketamine
      • Biased Ex 2: Benefits of Ketamine
      • Unbiased Ex: Prehospital use of Ketamine
    • “Witch hunting” for invalidating factors in quality research that does not align with your position.
    • Overlooking confounders in research that supports your position.
    • Superficial Investigation- Ending your evaluation of the literature before finding all of the related resources.

Diagnosis Errors

  • Diagnosis can be affected by numerous cognitive errors.
      • Anchoring Bias- Example: You arrive on scene and are met by the patient’s wife, who states “He’s in the kitchen, he can’t breathe!” The patient looks sick but is not in severe respiratory distress.  After launching a barrage of respiratory treatments, you initiate transport.  After giving a textbook alert to the receiving ED, you decide to get a quick 12 lead before you arrive.  As you pull into the ambulance bay of the small community hospital, you take note of the massive inferior MI the patient appears to be having.
      • Ascertainment Bias- Example: After determining that your six-year-old patient is unresponsive secondary to a narcotic overdose (due to prejudicial feelings about the neighborhood), you give naloxone, intubate and transport.  At the hospital, the nurse informs you that the patient’s serum glucose is 10 mg/dL & the tox screen shows no opiates.

    • Confirmation Bias- Example: A young woman in her mid 20’s experiences a syncopal episode at her place of employment.  You note that her serum glucose is 60 mg/dL and make your diagnosis of hypoglycemia.  To nail down the diagnosis, you ask questions such as: “When was the last time you ate?” She replies, “about 4 hours ago.” You close the case without obtaining a 12-Lead.
      • Note: Hypoglycemia does not cause syncope
    • Blind Spot Bias
      • Neglect or Refusal to see our own weaknesses and errors.
      • Similar to the Dunning-Kruger Effect
      • Example- Your management of a high acuity patient is less than optimal, rather than noting your deficiencies, you rationalize why your actions were correct for the situation.

Cognitive Bias

Confusing Experience with Bias

  • Experience is essential to acquire a skill.
  • Disregard for credible, current evidence “because of your experience” is a bias of one type or another or many!

How Can We Avoid Bias?

  • Learn as much as you can about bias and other cognitive errors
  • Question everything you think you know
  • Admit to yourself when you know you are wrong or don’t know something
  • Use cognitive aids

Thanks for listening/reading, please take a moment to follow the site via email, so you don’t miss any future episodes!  You can also follow me on Twitter, Facebook, and Instagram, so you can let me know what you think of the show & the site!  Many of the posts and podcast episodes come from your suggestions, so I would love to hear those as well!  Until next time, stay safe & treat aggressively!

Owen Wood


Bias. Merriam-Webster. [accessed 2017 Dec 11].

Morgenstern J. Cognitive errors in medicine: The common errors. First10EM. 2015 Dec 22 [accessed 2017 Dec 15].

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