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Cited by 49Clinical Reasoning and Diagnostic SkillsPatient Safety and Medication ErrorsDecision-Making and Behavioral Economics

Cognitive biases encountered by physicians in the emergency room

Open access
Kunitomo, Kotaro, Harada, Taku, Watari, Takashi·2022·BMC Emergency Medicine
DOI 10.1186/s12873-022-00708-3PMC PMC9414136
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Abstract

Background: Diagnostic errors constitute an important medical safety problem that needs improvement, and their frequency and severity are high in emergency room settings. Previous studies have suggested that diagnostic errors occur in 0.6-12% of first-time patients in the emergency room and that one or more cognitive factors are involved in 96% of these cases. This study aimed to identify the types of cognitive biases experienced by physicians in emergency rooms in Japan. Methods: We conducted a questionnaire survey using Nikkei Medical Online (Internet) from January 21 to January 31, 2019. Of the 159,519 physicians registered with Nikkei Medical Online when the survey was administered, those who volunteered their most memorable diagnostic error cases in the emergency room participated in the study. EZR was used for the statistical analyses. Results: A total of 387 physicians were included. The most common cognitive biases were overconfidence (22.5%), confirmation (21.2%), availability (12.4%), and anchoring (11.4%). Of the error cases, the top five most common initial diagnoses were upper gastrointestinal disease (22.7%), trauma (14.7%), cardiovascular disease (10.9%), respiratory disease (7.5%), and primary headache (6.5%). The corresponding final diagnoses for these errors were intestinal obstruction or peritonitis (27.3%), overlooked traumas (47.4%), other cardiovascular diseases (66.7%), cardiovascular disease (41.4%), and stroke (80%), respectively. Conclusions: A comparison of the initial and final diagnoses of cases with diagnostic errors shows that there were more cases with diagnostic errors caused by overlooking another disease in the same organ or a disease in a closely related organ.

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  • Overconfidence is one of the most common biases in the clinical setting, as clinicians sometimes trust their own judgment more than engaging in thorough investigations.

    “Overconfidence is one of the most common biases in the clinical setting [103], as clinicians sometimes trust their own judgment more than engaging in thorough investigations.”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [103]

    The Results report that overconfidence was the most common bias identified (22.5%), and the Conclusions list it among the most common biases in the emergency room. The claim extends that finding to clinical settings generally, whereas this study examined emergency-room diagnostic errors. (LLM, conf=0.84)

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References 40 · Cited by 49

Research works printed but not linked: 34

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Authors
Kunitomo, K., Harada, T., & Watari, T.
Affiliations
  • Kumamoto Medical Center (JP)
  • Koto Hospital (JP)
  • Shimane University (JP)
Corresponding author
Watari, Takashi
ORCID
Venue
BMC Emergency Medicine
Publisher
Springer Science and Business Media LLC
Published
2022-08-26
Volume
22
Issue
1
Pages
148-148
ISSN
1471-227X (ISSN-L)
DOI
10.1186/s12873-022-00708-3
PMC
PMC9414136
OpenAlex
W4293230553
Cited by
49
References
40
Citations by year
2026: 21 · 2025: 15 · 2024: 7 · 2023: 6
FWCI
8.30
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Emergency Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by)
Funders
Japan Society for the Promotion of Science (20H03913)
Topics
  • Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
Keywords
diagnostic errors, cognitive biases, emergency physicians, overconfidence, confirmation bias, anchoring effect, availability bias, missed diagnosis, trauma (physical injury), cardiovascular disease, stroke, upper gastrointestinal diseases, primary headache, medical safety
MeSH terms
Cardiovascular Diseases, Cognition, Diagnostic Errors, Emergency Service, Hospital, Humans, Physicians, Bias

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