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American journal of obstetrics and gynecology2020; 222(5); 469.e1-469.e3; doi: 10.1016/j.ajog.2020.01.010

Horses and zebras: probabilities, uncertainty, and cognitive bias in clinical diagnosis.

Abstract: Medical diagnosis is typically an iterative process guided by integration and synthesis of data into a model of disease. However, facts are not the only inputs into this process. A case of medical mis-diagnosis is presented, in which systematic cognitive bias is considered to have played a role in generating error. Specific cognitive biases are cited, and measures that can be taken to minimize their negative impact are reviewed.
Publication Date: 2020-01-16 PubMed ID: 31954699DOI: 10.1016/j.ajog.2020.01.010Google Scholar: Lookup
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  • Journal Article

Summary

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This research article investigates the role of cognitive bias in the process of medical diagnosis, presenting a case of misdiagnosis as an example. The study also discusses pertinent cognitive biases and methodologies to mitigate their adverse effects.

Overview

The article delves into the intricate process of medical diagnosis, first detailing how this procedure usually commands a repetitive and integrative assessment and aggregation of various data to establish a disease model. The discussion then transitions into an examination of how cognitive bias can infiltrate this procedure, skewing the results and leading to errors, as illustrated by a provided misdiagnosis case study.

  • The article insinuates that while facts form the backbone of diagnosis, they are not the only components involved in this process, highlighting the potential influence of cognitive elements.

Case of Medical Misdiagnosis

The study entails a substantial discourse on a particular misdiagnosis case, implicated as a result of systematic cognitive bias. This is an effort to squarely illustrate a real-world instance of how cognitive biases can intervene and command outliers in the medical diagnosis process.

  • The account of the medical misdiagnosis provides readers with a tangible example of the potential pitfalls of cognitive bias.
  • It suggests that cognitive biases can result in systematic errors, driving misdiagnoses.

Cognitive Biases in Diagnosis

Further on in the article, the authors present an outline of particular cognitive biases believed to significantly impact the medical diagnostic process. This section aims to draw attention to certain cognitive elements that may potentially corrupt the diagnostic process and lead to errors.

  • The authors provide a catalogue of specific cognitive biases, highlighting their potential influence and harm in the diagnosis process.
  • Understanding these biases, according to the authors, can assist in acknowledging and examining possible areas of improvement in diagnostic methodologies.

Minimizing the Negative Impact of Cognitive Bias

The finality of the article lies in the exploration of methods that could be adopted to mitigate the adverse effects of cognitive bias on the medical diagnosis process. The authors draw upon various ways that could be used to suppress any negative fallout from cognitive biases.

  • The paper underscores the significance of understanding and recognizing cognitive biases in the medical profession and discusses potential solutions to reduce their negative impact on the diagnostic process.
  • The ultimate goal of this section is to present a paradigm that promotes the optimization of diagnostic precision by controlling for cognitive biases.

Cite This Article

APA
Hirsch E. (2020). Horses and zebras: probabilities, uncertainty, and cognitive bias in clinical diagnosis. Am J Obstet Gynecol, 222(5), 469.e1-469.e3. https://doi.org/10.1016/j.ajog.2020.01.010

Publication

ISSN: 1097-6868
NlmUniqueID: 0370476
Country: United States
Language: English
Volume: 222
Issue: 5
Pages: 469.e1-469.e3
PII: S0002-9378(20)30014-4

Researcher Affiliations

Hirsch, Emmet
  • Department of Obstetrics and Gynecology, NorthShore University Health System. Evanston, IL; Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, IL. Electronic address: ehirsch@northshore.org.

MeSH Terms

  • Diagnosis, Differential
  • Diagnostic Errors
  • Female
  • Genital Diseases, Female / diagnosis
  • Humans
  • Uncertainty

Citations

This article has been cited 4 times.
  1. Almahloul Z, Amro B, Nagshabandi Z, Alkiumi I, Hakim Z, Wattiez A, Tahlak M, Koninckx PR. Ovarian Pregnancy: 2 Case Reports and a Systematic Review. J Clin Med 2023 Feb 1;12(3).
    doi: 10.3390/jcm12031138pubmed: 36769786google scholar: lookup
  2. More P, Mishra M, Mohamed S. Ovarian Ectopic Pregnancy: A Case Report of Two Cases Highlighting Diagnostic and Management Challenges. Cureus 2025 Sep;17(9):e92159.
    doi: 10.7759/cureus.92159pubmed: 41084668google scholar: lookup
  3. Ota K, Takahashi T, Ota Y, Saito W, Nishimura H, Moriya T, Shimoya K. Pathogenesis and symptom of early hemorrhage in extrafollicular ovarian pregnancy onset at 4weeks gestation: A case report. Int J Surg Case Rep 2025 Aug;133:111647.
    doi: 10.1016/j.ijscr.2025.111647pubmed: 40669196google scholar: lookup
  4. Giaume L, Lamblin A, Pinol N, Gignoux-Froment F, Trousselard M. Evaluating cognitive bias in clinical ethics supports: a scoping review. BMC Med Ethics 2025 Jan 30;26(1):16.
    doi: 10.1186/s12910-025-01162-zpubmed: 39885477google scholar: lookup