Medical Misdiagnosis: Your “Window on the World”

For the last decade I’ve used the simple, science-smart metaphor of a Brain Frame to enable healthcare professionals to understand the limitations in their own points of view. Clients tell me that, after hearing this metaphor, their conference attendees are more open to each other, to the ideas of the other conference speakers and to the notion that they might be overlooking something important. This open mindset breaks down silos, prepares people for (inevitable) change, and reduces the incidence of medical misdiagnosis.

In this article, I’ll briefly outline how I present the Brain Frame metaphor to clinicians in a keynote/workshop context…

The Brain Frame

It’s as if we see the world through a mental version of a picture frame. Just like a picture frame, this “Brain Frame” directs our attention towards what it surrounds and away from everything else. This can skew our thinking and always limits our outlook.

Skews Our Thinking

The way we frame a situation influences our judgment. In one study, the same survival statistic (for the surgical treatment of lung cancer) was presented to physicians in two different ways…

One group of doctors was told that the one-month survival rate following surgery is 90%.
The other group was told that there is 10% mortality following surgery in the first month.

Now, if you give it a moment’s thought it’s obvious that 90% survival equals 10% mortality. If 90% of the cancer patients survive the first month then it follows that the other 10% do not; same information, different frame.

Which way did the physicians jump? In the study, when the statistic was framed in terms of “survival,” 84% of the doctors opted for surgery over radiotherapy. When framed in terms of “mortality,” only 50% favored surgical treatment for the lung cancer.

Limits Our Outlook

One of the ways that Brain Frames limit our outlook is that we tend to only see what we expect to see. The unexpected remains outside our Brain Frame and therefore invisible to us.

Even experts are prone to only seeing what they expect to see. A woman in her forties presented in the ER with internal bleeding. In this situation, it’s standard practice to pass a central line. Unfortunately, on this occasion, the attending physician forgot to remove the guide wire that’s used to position the tube inside the patient’s vein. During the course of her treatment the patient received three chest X-rays and a CT scan. Yet, despite being clearly visible on all three films and the scan, the guide wire was overlooked by several physicians, for several days. The physicians didn’t expect to see a guide wire and so didn’t see it.

Reframing Tactics

The Brain Frame metaphor also suggests a simple way to hack our default thinking and sharpen our reasoning skills. During my surgical training I was always struck by how a simple adjustment of the light source gave a totally different look to the operating field. In a similar way, mindfully reframing a problem or a decision can dramatically transform how we see it.

For example, in his excellent book “How Doctors Think,” Dr. Jerome Groopman recounts a medical case concerning a young woman who despite eating 3000 calories a day, was dying from weight loss. All her doctors knew for a fact that she was non-compliant and bulimic. In other words, she wasn’t really eating all those calories and anything that did pass her lips, passed her lips twice; an accusation she strongly denied.

Only one physician, Dr. Myron Falchuk, reframed the clinical situation from the opposite point of view and gave his patient the benefit of the doubt. He chose to believe that this young woman was telling the truth: “And if I do [believe you], then why aren’t you gaining weight?” By exploring the implications of this opposite perspective, he correctly diagnosed celiac sprue—a disease of malabsorption—and saved the patient’s life.

Presenting These Ideas

Doctors can’t guard against making cognitive errors if they don’t know about them, and most doctors don’t know about them. They’ve never been taught well-recognized, predictable errors of judgment like anchoring, availability bias, framing effects and the confirmation bias. These can all be quickly and easily explained using the Brain Frame metaphor.

In my experience the quickest way to create buy-in among savvy audiences is to present this powerful metaphor in conjunction with striking visual illusions. There are many demonstrations on video that can be used to expose mission-critical perceptual and cognitive errors from the front of the room, in real time.

The Brain Frame metaphor can also be used to organize and outline simple reframing tactics that will improve a clinician’s diagnostic accuracy and sharpen his/her reasoning skills in other areas of life.

I’ve found that, when presented in this interactive, non-judgmental way, clinicians are very open to the notion of misdiagnoses arising from defined cognitive errors and to reframing as a path to improved diagnostic accuracy.

Got Questions? Give me a call +1 (972) 352 6622 or send an email: Steve[at]SteveBedwell.com