What fascinates me is how little many doctors understand about the basic functions of human thinking. This is known as bias blind spot. In a conversation recently, I was asked why many doctors don't appreciate that their thinking can be flawed. I considered this for a moment. 'Perhaps,' I said, 'it is because knowledge is valued so highly in medicine. Even today, the consultant with all their years of experience and vast accumulated knowledge is considered the top of the hierarchy, respected by everyone else, hardly ever wrong. People think that more experience means less mistakes. The notion that all of that is irrelevant when it comes to being prone to cognitive errors challenges this strongly held belief ...'
Talk of cognitive errors is also new to medicine. Many things we now understand about human decision making are relatively new in cognitive psychology. So most older doctors don't even have a vocabulary to talk about clinical reasoning. In a survey asking whether junior members of the team should be able to question decisions made by senior team members, pilots were almost unanimous in saying they should. By contrast, in the same survey, 25% of consultant surgeons stated that junior members of staff should not question seniors. This study was performed to look at the influence of hierarchy and human factors training on communication within teams. Systems improvements and mandatory training in human factors (which includes the limitations of human performance) have transformed aviation from a risky enterprise to one of the safest forms of travel. As James Reason put it: 'Good doctors are not those who don't make mistakes; good doctors are those who expect to make mistakes and act on that expectation.'
Croskerry P. Bias: a normal operating characteristic of the diagnosing brain. Diagnosis 2014; 1(1): 23-7.