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Author Credentials

Talal Asif, MD, Ravali Gummi, MSV, Zara Wadood, MD, Kristy E. Steigerwalt, PharmD, Rebecca R. Pauly, MD

DOI

http://dx.doi.org/10.18590/mjm.2017.vol3.iss2.4

Abstract

Cognitive errors are the most common cause of diagnostic errors in the process of clinical decision making. Recently, there has been an immense focus on the new science of error prevention in health care. Anchored thinking or heuristics is a form of cognitive error that portrays shortcuts or abbreviated thinking in the light of diagnostic uncertainty. The risk is of comfort in a typical scenario and not being able to adapt to a new situation. Here we present an intriguing case of acute appendicitis in a patient who was initially admitted and treated for hypothermia and alcohol withdrawal. As the patient recovered from his withdrawal and neared the end of his hospital stay, he developed persistent leukocytosis, mild metabolic acidosis and vague abdominal discomfort, leading us to pursue further work up resulting in a new diagnosis. If unrecognized, delayed diagnosis and significant harm with potential for rupture of the appendix, peritonitis, significant morbidity and even mortality could have occurred. This case serves as an example of how to avoid errors resulting from heuristic thinking for the reason that incongruity of data was specifically looked for and consequently recognized.

Conflict(s) of Interest

None

References with DOI

1. Chapman GB, Johnson EJ. Incorporating the irrelevant: anchors in judgments of belief and value. In: Gilovich T, Griffin DW, Kahneman D, editors. Heuristics and biases: the psychology of intuitive judgment. Cambridge (UK): Cambridge University Press; 2002. p. 120-38. https://doi.org/10.1017/cbo9780511808098.008

2. Wilson TD, Houston CE, Etling KM, Brekke N. A new look at anchoring effects: basic anchoring and its antecedents. J Exp Psychol Gen. 1996;125(4):387-402. https://doi.org/10.1037/0096-3445.125.4.387

3. Epstein RM. Mindful practice. JAMA. 1999;282(9):833-9.

4. Milkman KL, Chugh D, Bazerman MH. How can decision making be improved? Perspect Psychol Sci.2009;4(4):379-83.

5. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA‐Ar). Br J Addict.

1989;84(11):1353-7. ttps://doi.org/10.1111/j.1360-0443.1989.tb00737.x

6. Mazzei MA, Guerrini S, Cioffi Squitieri N, Cagini L, Macarini L, Coppolino F, et al. The role of US

examination in the management of acute abdomen. Crit Ultrasound J. 2013;5 Suppl 1:S6. https://doi.org/10.1186/2036-7902-5-s1-s6

7. Sinclair D, Croskerry P. Patient safety and diagnostic error: tips for your next shift. Can Fam Physician.2010;56(1):28-30.

8. Misch, DA. A piece of my mind. I feel witty, oh so witty. JAMA. 2016;315(4):345-6. https://doi.org/10.1001/jama.2015.16758

9. Wray CJ, Kao LS, Millas SG, Tsao K, Ko TC. Acute appendicitis: controversies in diagnosis and management. Curr Probl Surg. 2013;50(2):54-86. https://doi.org/10.1067/j.cpsurg.2012.10.001

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