Availability Bias Causes Misdiagnoses by Physicians: Direct Evidence from a Randomized Controlled Trial
Open accessAbstract
Objective Empirical evidence on the availability bias associated with diagnostic errors is still insufficient. We investigated whether or not recent experience with clinical problems can lead physicians to make diagnostic errors due to availability bias and whether or not reflection counteracts this bias. Methods Forty-six internal medicine residents were randomly divided into a control group (CG) and experimental group (EG). Among the eight clinical cases used in this study, three experimental cases were similar to the disease of dengue fever (DF) but exhibited different diagnoses, one was actually DF, and the other four filler cases were not associated with DF. First, only the EG received information on DF, while the CG knew nothing about this study. Then, six hours later, all participants were asked to diagnose eight clinical cases via nonanalytic reasoning. Finally, four cases were diagnosed again via reflective reasoning. Results In stage 2, the average score of the CG in the diagnosis of experimental cases was significantly higher than that of the filler cases (0.80 vs. 0.59, p<0.01), but the EG's average score in the two types of cases was not significantly different (0.66 vs. 0.64, p=0.756). The EG and CG had significantly different scores for each experimental case, while no difference was observed in the filler cases. The proportion of diseases incorrectly diagnosed as DF among experimental cases ranged from 71% to 100% in the EG. There were no significant differences between the mean diagnostic accuracy scores obtained by nonanalytic reasoning and those obtained by the reflective reasoning in any cases. Conclusion Availability bias led to diagnostic errors. Misdiagnoses cannot always be repaired solely by adopting a reflective approach.
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When there are recent or notable cases, clinicians tend to make a diagnosis based on these events, often overlooking other factors that may be more relevant or more closely aligned with the patient's symptoms.
“when there are recent or notable cases, clinicians tend to make a diagnosis based on these events, often overlooking other factors that may be more relevant or more closely aligned with the patient’s symptoms [102].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [102]
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References 25 · Cited by 31
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- [1]Tversky A, Kahneman D Judgment under uncertainty: heuristics and biases. Science 185: 1124- 1131, 1974. 17835457
- [2]Cain DM, Detsky AS Everyone's a little bit biased (even physicians). JAMA 299: 2893- 2895, 2008. 18577735
- [3]Marewski JN, Gigerenzer G Heuristic decision making in medicine. Dialogues Clin Neurosci 14: 77- 89, 2012. 22577307 PMC3341653
- [4]McDonald CJ Medical heuristics: the silent adjudicators of clinical practice. Ann Intern Med 124: 56- 62, 1996. 7503478
- [5]Redelmeier DA The cognitive psychology of missed diagnoses. Ann Intern Med 142: 115- 120, 2005. 15657159
- [8]Brennan TA, Leape LL, Laird NM, et al Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. Qual Saf Health Care 13: 145- 151, 2004. 15069223 PMC1743811
- [9]Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD The quality in Australian health care study. Med J Aust 163: 458- 471, 1995. 7476634
- [10]Thomas EJ, Studdert DM, Burstin HR, et al Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 38: 261- 271, 2000. 10718351
- [11]Baron J Thinking and Deciding. Cambridge University Press, New York, 2000.
- [12]Lucchiari C, Pravettoni G Cognitive balanced model: a conceptual scheme of diagnostic decision making. J Eval Clin Pract 18: 82- 88, 2012. 21999310
- [14]Mamede S, van Gog T, van den Berge K, et al Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA 304: 1198- 1203, 2010. 20841533
- [15]Schmidt HG, Mamede S, Van Den, Berge K, et al Exposure to media information about a disease can cause doctors to misdiagnose similar-looking clinical cases. Acad Med 89: 285- 291, 2014. 24362387
- [16]Evans JS Dual-processing accounts of reasoning, judgment, and social cognition. Annu Rev Psychol 59: 255- 278, 2008. 18154502
- [17]Sherbino J, Dore KL, Wood TJ, et al The relationship between response time and diagnostic accuracy. Acad Med 87: 785- 791, 2012. 22534592
- [18]Kahneman D, Tversky A On the study of statistical intuitions. Cognition 11: 123- 141, 1982. 7198957
- [19]Mamede S, Schmidt HG, Rikers RM, et al Influence of perceived difficulty of cases on physicians' diagnostic reasoning. Acad Med 83: 1210- 1216, 2008. 19202502
- [20]Croskerry P Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med 9: 1184- 1204, 2002. 12414468
- [21]Norman GR, Rosenthal D, Brooks LR, et al The development of expertise in dermatology. Arch Dermatol 125: 1063- 1068, 1989. 2757402
- [22]Lehr JL, Lodwick GS, Farrell C, et al Direct measurement of the effect of film miniaturization on diagnostic accuracy. Radiology 118: 257- 263, 1976. 1250956
- [23]Norman GR, Eva KW Diagnostic error and clinical reasoning. Med Educ 44: 94- 100, 2010. 20078760
- [25]Schmidt HG, Norman GR, Boshuizen HP A cognitive perspective on medical expertise: theory and implication. Acad Med 65: 611- 621, 1990. 2261032
- Authors
- Li, P., Cheng, Z. Y., & Liu, G. L.
- Affiliations
- Wenzhou Medical University (CN)
- ORCID
- Li, Ping
- Venue
- Internal Medicine
- Published
- 2020-12-15
- Volume
- 59
- Issue
- 24
- Pages
- 3141-3146
- ISSN
- 0918-2918 (ISSN-L)
- 1349-7235
- PMC
- PMC7807127
- OpenAlex
- W3048372295
- Cited by
- 31
- References
- 25
- Citations by year
- 2026: 9 · 2025: 2 · 2024: 9 · 2023: 7 · 2022: 3 · 2021: 1
- FWCI
- 3.04
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- other-oa
- Locations
- Internal Medicine (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Wenzhou Medical University
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- availability bias, diagnostic errors, misdiagnosis, dengue, reflective thinking, physician decision-making, internal medicine residents
- MeSH terms
- Diagnosis, Differential, Diagnostic Errors, Humans, Physicians
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