Framing of clinical information affects physicians' diagnostic accuracy

Area of Science:

• Medical Education
• Cognitive Bias in Medicine
• Diagnostic Error Research

Background:

• Framing bias influences decision-making by emphasizing information presentation over objective facts.
• The way a medical problem is framed can significantly shape a diagnostician's perception.
• This study investigates whether framing bias leads to clinically significant diagnostic errors.

Purpose of the Study:

• To determine if framing bias causes clinically meaningful diagnostic errors in medical professionals.
• To assess the impact of information framing on differential diagnoses and investigation choices.

Main Methods:

• Three hypothetical clinical cases were developed.
• Two case presentations were framed to either support or detract from a specific diagnosis (pulmonary embolus, interstitial lung disease).
• Physicians' differential diagnoses and investigation lists were compared based on the framed presentations.

Main Results:

• Significant differences in differential diagnoses were observed based on case framing.
• Pulmonary embolus and interstitial lung disease were more frequently considered and investigated when the case was framed towards them.
• The framing effect was robust and not influenced by clinician seniority or baseline risk aversion.

Conclusions:

• Framing bias demonstrably causes clinically meaningful diagnostic errors, evidenced by investigation choices.
• The study highlights the impact of framing on diagnostic reasoning and ordered investigations.
• Findings have implications for medical handovers and teaching clinical communication skills to junior doctors.