Anchoring bias. A reflection from Dr Sham.

anchoring bias

Anchoring is a cognitive bias whereby an individual depends too heavily on the initial information when making decisions. An excellent example of this would be red flags symptoms referred to the hospital on a two-week basis.  It’s fair to say that there is reassurance from referring to the cancer fast track clinics. However, one of the things that I’ve realised is that when a specific cancer is excluded, the patient is often referred back to primary care. Is that enough to say that the patient could not have cancer at an alternative site? Similarly, a patient has an acute issue and has an ED or speciality assessment. Is it enough for me to say that it’s been adequately excluded?

I’ve been working as a General Practitioner for almost four months. I’ve worked pretty much full-on since qualifying, and it’s now at approximately 1,920 consultations that I’m going to share a reflection on my time as a newly qualified GP.

 

The first question I’d like to ask you is whether or not it’s possible to be too thorough, and is there a risk of this?

 

When I think back to my time as a trainee, I was often told, common things are common, and the recognition of this would come with experience. Without being too harsh on myself, I’ve most definitely worked on that, and I’m a little better at dealing with uncertainty as well as using time as a diagnostic tool.

 

Both of which are key areas of the GP trainee portfolio. If you’re a GP trainee and you’d like some support with the GP trainee portfolio, check out our guides here!

 

I’ve recently dealt with several scenarios that fit into two categories, which have made me consider whether or not I should rely on the information that I’ve been given.

 

The specialist says no!

 

The findings are normal.

 

I’d love to know how many decisions I’ve made since qualifying as a GP. Even the most straightforward low mood presentations will require at least eight decisions, if not more!

 

Is the patient safe?

Are they at risk to others?

Should I prescribe medication?

Should I refer the patient?

Should the patient consider talking therapies?

Would they benefit from time off work?

Are there any contraindications?

When should I review them next?

 

So what happens when your decision making is influenced by the first piece of information that you receive…

 

What is anchoring bias?

 

Anchoring is a cognitive bias whereby an individual depends too heavily on the initial information when making decisions.

 

An excellent example of this would be red flags symptoms referred to the hospital on a two-week basis. 

 

It’s fair to say that there is reassurance from referring to the cancer fast track clinics. However, one of the things that I’ve realised is that when a specific cancer is excluded, the patient is often referred back to primary care.

 

Is that enough to say that the patient could not have cancer at an alternative site?

 

Similarly, a patient has an acute issue and has an ED or speciality assessment. Is it enough for me to say that it’s been adequately excluded?

 

The specialist says no!

 

My take-home has been that if a patient presents following a recent hospital admission or assessment and the discharge summary is below par (which is often the case!), you have to try and understand as much as you can about what happened during that assessment. 

 

Following this, you can make a more precise assessment of whether the patient needs further investigation from primary care.

 

My inquisitive nature may be a little much at times. Having generated a positive outcome for two patients, I’d much rather be interested than blasé.

 

The findings are normal!

 

Our threshold of normal can vary on a day to day basis. What we consider normal for a patient may well depend on their considered normal.

 

I do find it difficult to accept something is normal without having glanced over the result myself. This very much comes from my experience in Emergency Medicine. In my capacity as a registrar, I was often shown an investigation and told it was normal before I could analyse the result.

 

I’ve experienced this with ECGs. 

 

If a patient attends with chest pain, the ECG is almost always analysed in light of the chest pain presentation. This doesn’t mean that the ECG is always normal!

 

Having worked in that environment, I know that my workup and relationship with ECGs as a GP is much different. If there is a chronic abnormality, I’d be much more comfortable with a baseline echocardiograph.

 

Left axis deviation may not mean too much in an acute chest pain history. Still, on the other hand, a left axis deviation in a fascicular block associated with dizziness may need further investigation.

 

I really hope that you’ve found this blog interesting. We all practice medicine in our own ways, but I hope this blog gives you something to think about. If you’ve found this blog to be helpful, consider sharing it on your social media, or with your friends!

I’d love to hear your thoughts, so do send me an email at sham@wellmedic.co.uk or catch me on Instagram @wellmedicsham.

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