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Exposure to Media Information About a Disease Can Cause Doctors to Misdiagnose Similar-Looking Clinical Cases

Schmidt, Henk G. PhD; Mamede, Sílvia MD, PhD; van den Berge, Kees MD, PhD; van Gog, Tamara PhD; van Saase, Jan L.C.M. MD, PhD; Rikers, Remy M.J.P. PhD

doi: 10.1097/ACM.0000000000000107
Research Reports

Purpose: Anecdotal evidence indicates that exposure to media-distributed disease information, such as news about an outbreak, can lead physicians to errors; influenced by an availability bias, they misdiagnose patients with similar-looking but different diseases. The authors investigated whether exposure to media-provided disease information causes diagnostic errors and whether reflection (systematic review of findings) counteracts bias.

Method: In 2010, 38 internal medicine residents first read the Wikipedia entry about one or another of two diseases (Phase 1). Six hours later, in a seemingly unrelated study, they diagnosed eight clinical cases (Phase 2). Two cases superficially resembled the disease in the Wikipedia entry they had read (bias expected), two cases resembled the other disease they had not read about (bias not expected), and four were filler cases. In Phase 3, they diagnosed the bias-expected cases again, using reflective reasoning.

Results: Mean diagnostic accuracy scores (Phase 2; range: 0–1) were significantly lower on bias-expected cases than on bias-not-expected cases (0.56 versus 0.70, P = .016) because participants misdiagnosed cases that looked similar to a Wikipedia description of a disease more often when they had read the Wikipedia description (mean = 0.61) than when they had not (mean = 0.29). Deliberate reflection (Phase 3) restored performance on bias-expected cases to pre-bias levels (mean = 0.71).

Conclusions: Availability bias may arise simply from exposure to media-provided information about a disease, causing diagnostic errors. The bias’s effect can be substantial. It is apparently associated with nonanalytical reasoning and can be counteracted by reflection.

Prof. Dr. Schmidt is professor, Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands.

Dr. Mamede is associate professor, Institute of Medical Education Research Rotterdam, Erasmus Medical Center, and associate professor, Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands.

Dr. van den Berge is resident, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.

Prof. Dr. van Gog is professor, Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands.

Prof. Dr. van Saase is professor, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.

Prof. Dr. Rikers is professor, Department of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands.

Editor’s Note: A commentary by P. Croskerry, D.A. Petrie, J.B. Reilly, and G. Tait appears on pages 197–200.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: The ethics committee of the Department of Psychology, Erasmus University Rotterdam, gave approval for the study.

Correspondence should be addressed to Dr. Schmidt, Department of Psychology, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands; telephone: (+31) 104082064; e-mail: Schmidt@fsw.eur.nl.

© 2014 by the Association of American Medical Colleges