Table 1

High-risk situations for biased reasoning

High-risk situationPotential biases
1. Was this patient handed off to me from a previous shift?Diagnosis momentum, framing
2. Was the diagnosis suggested to me by the patient, nurse or another physician?Premature closure, framing bias
3. Did I just accept the first diagnosis that came to mind?Anchoring, availability, search satisficing, premature closure
4. Did I consider other organ systems besides the obvious one?Anchoring, search satisficing, premature closure
5. Is this a patient I don't like, or like too much, for some reason?Affective bias
6. Have I been interrupted or distracted while evaluating this patient?All biases
7. Am I feeling fatigued right now?All biases
8. Did I sleep poorly last night?All biases
9. Am I cognitively overloaded or overextended right now?All biases
10. Am I stereotyping this patient?Representative bias, affective bias, anchoring, fundamental attribution error, psych out error
11. Have I effectively ruled out must-not-miss diagnoses?Overconfidence, anchoring, confirmation bias

  • Adapted from Graber:34 General checklist for AHRQ project.

  • A description of specific biases can be found in Croskerry.7