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The following is a summary of “Using case vignettes to study the presence of outcome, hindsight, and implicit bias in acute unplanned medical care: a cross-sectional study,” published in the August 2024 issue of Emergency Medicine by Plaum et al.
Various biases, including outcome and hindsight biases, influence decision-making and judgment of cases in the ED, leading to incorrect retrospective assessments of care quality, while implicit bias results in unequal treatment based on irrelevant patient characteristics.
Researchers conducted a retrospective study to evaluate factors influencing physicians’ quality of care assessments and compare the treatment received by patients with functional disorders versus those with a medical history.
They conducted a study with 191 Dutch emergency physicians (EPs) and general practitioners (GPs) who received case vignettes describing patient care. The vignette outcomes were distributed randomly as no, good, and bad. EPs rated the quality of care for 4 case vignettes with varying outcomes and were about the patient’s medical history (somatic or functional), making treatment and diagnostic decisions accordingly. Rating was done on a likert scale (0–5) and dichotomized as adequate (yes/no) to estimate the likelihood of patients with bad outcomes due to hindsight bias, EPs also prescribed analgesics and additional diagnoses.
The results showed significant differences in rated quality of care for 3 out of 4 vignettes based on different case outcomes. For instance, EP rated the quality of care as adequate in 44% (95% CI 33–57%) for abdominal pain with a bad outcome as compared to 88% (95% CI 78–94%) for a good outcome and 84% (95% CI 73–91%) for no outcome (P<0.01). The estimation of a bad outcome was higher when physicians were presented with a vignette featuring a bad patient outcome. Additionally, fewer diagnostic tests were performed, and opioids were prescribed.
They concluded outcome, hindsight, and implicit bias significantly influence decision-making and care quality assessment.
