Diagnostic Overshadowing: When Cognitive Biases Can Harm Patients

• Published in: American family physician Vol. 108; no. 3; pp. 292 - 294
• Main Authors: Lazris, Andy, MD, CMD, Roth, Alan, DO, FAAFP, FAAHPM, Haskell, Helen, James, John
• Format: Journal Article
• Language: English
• Published: Leawood American Academy of Family Physicians 01.09.2023
• Subjects: Bias; Chronic illnesses; Clinical outcomes; Family Medicine/General Medicine; Family physicians; Intellectual disabilities; Internal Medicine; Medical diagnosis; Medical personnel; Mental disorders; Mental health; Nursing care; Nursing homes; Obesity; Patients; Professionals; Psychologists; Stigma
• ISSN: 0002-838X; 1532-0650; 1532-0650

A 75-year-old woman had been living in a nursing home for several years. She had moderate dementia and took citalopram for severe anxiety. She often shouted that she was dying, prompting her physicians to add quetiapine to her treatment regimen to modify her disruptive behavior. One day, she woke up quieter than usual and said her head felt like it was exploding. Her nurse was concerned and contacted her physician. When the physician visited her later that day, she told him, “I feel dizzy, my head is exploding, and I'm going to die.” The physician told her to “calm down” and asked the nurse to administer a dose of lorazepam and the quetiapine earlier than scheduled. When the nurse visited the patient a few hours later, the patient was calm but obtunded. The patient was transported by ambulance to the hospital. Non-contrast head computed tomography found a large cerebral hemorrhage. The patient died a few hours later.