Cognitive Bias in the Management of a Critically Ill 29-Year-Old Patient

Cognitive bias is a significant issue in the management of critically ill patients. Often patients cannot communicate due to illness or mechanical ventilation, making history-taking difficult. Here we present a case where cognitive bias led the clinical team to treat the wrong diagnosis until the patient was in extremis.  We present a 29-year-old otherwise healthy female who initially presented to an outside facility with severe abdominal pain and hypotension. Due to a history of medical abortion two weeks prior, the patient was initially diagnosed with sepsis due to retained products of conception. Following a dilation and curettage that revealed no retained POC and worsening of the patient's symptoms, the patient was transferred to our facility for higher care. Over five additional days, the patient had a significantly worsening clinical picture before new diagnoses such as abdominal compartment syndrome, necrotic bowel, and adverse effects from diet pill cleanse were considered and acted upon. The patient ultimately suffered abdominal and bilateral lower extremity compartment syndrome leading to colectomy and bilateral below-the-knee amputations. As clinicians, we must provide the best care possible and reduce patient suffering. Cognitive bias is something that all clinicians must be aware of and learn to manage. Failure to be aware of one's cognitive bias puts the patient at risk and can be harmful. This case illustrates just how detrimental cognitive bias and misdiagnoses can be.