Yesterday I talked about cognitive miserliness – meaning the tendency to take the easy route in a diagnosis. The basis for this is much more complicated than I mentioned. Taking the easy route is a natural way for humans to think. The ability to react to a situation is part of an animal’s survival response after all. In emergency medicine you need to react quickly. This doesn’t mean that you haven’t thought about what you’re doing. But it does mean that you need to know your subject. Emergency medicine requires you to know the drugs that will be needed in any given situation and preferably have some ready reckoners for dosages on the wall. If an animal develops a heart block or even worse, you need to react. Whether it’s from experience or the textbook, you recognise the signs and know what to do. That’s why many practices will now rehearse what to do if an animal crashes. Knowing who does what in that situation could save an animal’s life. (Note – have a look at RECOVER guidelines for further info on this).
This quick response, known as Type 1, is a valid response but has a tendency to be affected more by bias than the slower Type 2 form of thinking. Various forms of bias exist.
Do you recognise any of these? I think all clinicians will be able to recognise at least one of these. That just means you’re human. The important thing is to recognise when bias happens and try to stop it. If you have a case that’s been on heart medication for years and still have a cough, maybe it’s time for a work up. Could it have a co-morbidity? That skin case could have developed another problem – atopic dogs are prone to Malassezia infections. Persistent pyodermas could be ringworm. If a case doesn’t respond the way you expect, then carry out a more detailed work up. Explain to owners that cases are not always one thing. Cases can change or develop other conditions.
That leads onto the importance of good communcation skills in decision making, but I'll leave that for another day.
J R Coll Physicians Edinb 2018; 48: 225–232 | doi: 10.4997/JRCPE.2018.306
Recover Guidelines https://recoverinitiative.org/cpr-guidelines/current-recover-guideline/