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Confirmation bias: why psychiatrists stick to wrong preliminary diagnoses

Published online by Cambridge University Press:  20 May 2011

R. Mendel ,
E. Traut-Mattausch ,
E. Jonas ,
S. Leucht ,
J. M. Kane ,
K. Maino ,
W. Kissling  and
J. Hamann
R. Mendel
Affiliation:
Department of Psychiatry, Technische Universität München, Germany
E. Traut-Mattausch
Affiliation:
Department of Psychology, Ludwig-Maximilians-Universität München, Germany
E. Jonas
Affiliation:
Department of Psychology, Universität Salzburg, Austria
S. Leucht*
Affiliation:
Department of Psychiatry, Technische Universität München, Germany
J. M. Kane
Affiliation:
Department of Psychiatry, The Zucker Hillside Hospital of the North Shore-Long Island Jewish Health System, USA
K. Maino
Affiliation:
Department of Psychiatry, Ludwig-Maximilians-Universität München, Germany
W. Kissling
Affiliation:
Department of Psychiatry, Technische Universität München, Germany
J. Hamann
Affiliation:
Department of Psychiatry, Technische Universität München, Germany
*
*Address for correspondence: PD Dr S. Leucht, Department of Psychiatry, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany. (Email: Stefan.Leucht@lrz.tu-muenchen.de)
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Abstract

Background

Diagnostic errors can have tremendous consequences because they can result in a fatal chain of wrong decisions. Experts assume that physicians' desire to confirm a preliminary diagnosis while failing to seek contradictory evidence is an important reason for wrong diagnoses. This tendency is called ‘confirmation bias’.

Method

To study whether psychiatrists and medical students are prone to confirmation bias and whether confirmation bias leads to poor diagnostic accuracy in psychiatry, we presented an experimental decision task to 75 psychiatrists and 75 medical students.

Results

A total of 13% of psychiatrists and 25% of students showed confirmation bias when searching for new information after having made a preliminary diagnosis. Participants conducting a confirmatory information search were significantly less likely to make the correct diagnosis compared to participants searching in a disconfirmatory or balanced way [multiple logistic regression: odds ratio (OR) 7.3, 95% confidence interval (CI) 2.53–21.22, p<0.001; OR 3.2, 95% CI 1.23–8.56, p=0.02]. Psychiatrists conducting a confirmatory search made a wrong diagnosis in 70% of the cases compared to 27% or 47% for a disconfirmatory or balanced information search (students: 63, 26 and 27%). Participants choosing the wrong diagnosis also prescribed different treatment options compared with participants choosing the correct diagnosis.

Conclusions

Confirmatory information search harbors the risk of wrong diagnostic decisions. Psychiatrists should be aware of confirmation bias and instructed in techniques to reduce bias.

Keywords

Confirmation biasdiagnosesinformation searchquality of decisions
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 12 , December 2011 , pp. 2651 - 2659
Copyright
Copyright © Cambridge University Press 2011

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