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    Even seasoned physicians can fall into cognitive bias traps

    Ophthalmologists should stay aware of potential biases in thinking to help make better diagnoses

     

    Intuitive versus analytical

    Ophthalmologists also should be aware of intuitive versus analytical thinking. Intuitive thinking is fast, automatic, and unconscious. Analytical thinking is slow, deliberate, and conscious.

    “We often use intuitive thinking, which is efficient, but that’s where errors most often occur,” Dr. Shaw said.

    Dr. Shaw shared a couple of cases in neuro-ophthalmology to make his point about thinking beyond the most obvious diagnosis.

    For example, in one case, a 39-year-old man presented with mild headaches and blurry vision. He was evaluated for papilloedema in the right eye. The exam did not find papilloedema, but it did find optic nerve drusen. The patient’s abnormal visual field result may lead the neuro-ophthalmologist to think the cause is the optic nerve drusen, but further analysis actually found something indicative of a chiasm lesion. The patient was found to have a pituitary tumor.

    “Sometimes, the obvious diagnosis may not be the most important,” he said. “When we hear hoofbeats, think about horses, but don’t forget about zebras.”

     

     

    Harold E. Shaw, MD

    E: [email protected]

    This article was adapted from Dr. Shaw’s presentation at Neuro-Ophthalmology Subspecialty Day during the 2015 meeting of the American Academy of Ophthalmology. He did not indicate any proprietary interest in the subject matter.

     

     

     

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