Trial Report Using case vignettes to study the presence of outcome, hindsight, & implicit bias in acute unplanned medical care: a cross-sectional study, 2024,Plaum

https://journals.lww.com/euro-emerg...e_vignettes_to_study_the_presence_of.114.aspx

Using case vignettes to study the presence of outcome, hindsight, and implicit bias in acute unplanned medical care: a cross-sectional study

Plaum, Patriciaa; Visser, Laura N.b; de Groot, Basc; Morsink, Marlies E.B.c; Duijst, Wilma L.J.M.d,e; Candel, Bart G.J.f,g

Author Information
European Journal of Emergency Medicine ():10.1097/MEJ.0000000000001127, February 16, 2024. | DOI: 10.1097/MEJ.0000000000001127

• OPEN
• SDC
• PAP

Abstract
Background and importance
Various biases can impact decision-making and judgment of case quality in the Emergency Department (ED). Outcome and hindsight bias can lead to wrong retrospective judgment of care quality, and implicit bias can result in unjust treatment differences in the ED based on irrelevant patient characteristics.

Objectives
First, to evaluate the extent to which knowledge of an outcome influences physicians’ quality of care assessment. Secondly, to examine whether patients with functional disorders receive different treatment compared to patients with a somatic past medical history.

Design
A web-based cross-sectional study in which physicians received case vignettes with a case description and care provided. Physicians were informed about vignette outcomes in a randomized way (no, good, or bad outcome). Physicians rated quality of care for four casevignettes with different outcomes. Subsequently, they received two more case vignettes. Physicians were informed about the past medical history of the patient in a randomized way (somatic or functional). Physicians made treatment and diagnostic decisions for both cases.

Setting and participants
One hundred ninety-one Dutch emergency physicians (EPs) and general practitioners (GPs) participated.

Outcome measures and analysis
Quality of care was rated on a Likert scale (0–5) and dichotomized as adequate (yes/no). Physicians estimated the likelihood of patients experiencing a bad outcome for hindsight bias. For the second objective, physicians decided on prescribing analgesics and additional diagnostic tests.

Main results
Large differences existed in rated quality of care for three out of four vignettes based on different case outcomes. For example, physicians rated the quality of care as adequate in 44% (95% CI 33–57%) for an abdominal pain case with a bad outcome, compared to 88% (95% CI 78–94%) for a good outcome, and 84% (95% CI 73–91%) for no outcome (P < 0.01). The estimated likelihood of a bad outcome was higher if physicians received a vignette with a bad patient outcome. Fewer diagnostic tests were performed and fewer opioids were prescribed for patients with a functional disorder.

Conclusion
Outcome, hindsight, and implicit bias significantly influence decision-making and care quality assessment by Dutch EPs and GPs.

Keywords:

bias; chronic fatigue syndrome; disciplinary law; fibromyalgia; functional disorders; health care; irritable bowel syndrome; judgment; medical errors; outcome assessment

 

Vulnerable groups, such as patients with functional disorders [e.g. irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), fibromyalgia], often feel their concerns are dismissed, and implicit bias may exacerbate disparities in care [11,12].
[..]
Participants were randomized in four groups, in which sex and the past medical history (functional or somatic/no past medical history) of the patient in the case differed (see Supplemental digital content 2, https://links.lww.com/EJEM/A427).

 

They had physicians rate the quality of care of patients? In a study of bias? Including about the quality of care of a group of patients that is systematically discriminated by physicians? That's actually impressive. In a very bad way.

Medicine is sometimes such a weird mix of crass capitalism and Soviet planned economy. The worst of both, in far too many cases. The needs are bottom-up, but the entire knowledge base is completely top-down.

In this survey of sexism and misogyny in social structures, we asked Catholic priests to rate the experience of nuns and their relations to male clergy...