Author Credentials

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


Anchored thinking


Internal Medicine


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.