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Are you too attached to the diagnosis?

Avoiding anchoring bias in EMS by balancing speed with safety


Anchoring bias may happen when providers become overly attached to a diagnosis even if there is contradicting evidence.

Helen H. Richardson/The Denver Post

In this episode of the MCHD Paramedic Podcast, we discuss something a little different from your typical medicine, but something that is crucial to patient management – and that is anchoring bias (i.e., becoming overly attached to a diagnosis even if there is contradicting evidence).

EM/EMS Physician Dr. Katherine Luu joins the podcast to discuss anchoring bias and how this impacts medics in the field, sharing the following example of how dangerous anchoring bias can be:

I learned this painfully as an ER resident working Halloween night. It happened to be Saturday night with a full moon and the end of daylight savings, so it was an extra hour of madness. I had already seen multiple intoxicated patients that night when EMS brought a 26 y/o male dressed as a pirate coming in for “intoxication and a fall while at a party.” No one was actually sure what happened, they just noticed him passed out on the ground.

On exam he was hemodynamically stable, awake but still intoxicated and agitated. He followed some commands and moved all extremities. Fingerstick was normal. Head imaging crossed my mind, but he was young and stable, so I was going to let him sleep it off and reassess. Fast forward 4 hours later and nurses report the patient was getting more somnolent and confused.

Head CT showed an intracranial bleed. Luckily, it was small and non-surgical, but I will never forget the drunk pirate as I anchored too soon on intoxication and nearly missed the head bleed.

Listen in as we break down some key principles on medical decision making and what you can do to avoid having your own drunk pirate, as we discuss:

  • Be a medical detective, ask more questions when it doesn’t make sense.
  • Reconsider the differential constantly. Does it fit? What else could it be?
  • Vital signs are vital for a reason. Revisit not just the patient, but also the differential when there is a sudden change.

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Read more:

How anchoring can cause medical errors

EMS providers need to understand anchoring, a type of cognitive bias, to prevent errors in prehospital patient assessment and care

The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.