If you haven’t seen these three things happen yet, you probably will soon now that you’re on watch for them:
– diagnostic overshadowing
– documentation resulting in a cascade of bias
– empathy failure

Together with Rebecca Callahan, I’ve written about diagnostic overshadowing before [here]. Diagnostic overshadowing is where current physical problems, symptoms or pathology gets overlooked, dismissed or downplayed because of the distraction of a documented history of a previous problem, eg: drug and/or alcohol use, mental health problems, or intellectual disability.

I was reminded of this when reading this excerpt from a recent article by Searby, Burr, James & Maude (2022):

I have a client who comes and sees me who has cirrhosis. I requested him to go and see a doctor at the local ED Department. ED don’t see him because they view him as just that junkie, just that drunk. This gentleman then has an acute exacerbation of his physical health, but it’s not seen as important…

Sound familiar? It’s not just in ED, it’s in other parts of the health system too.

Today I stumbled across a phrase I haven’t heard/read before: “a cascade of bias” (Martin, Bickle & Lok, 2022). The phrase “a cascade of bias” is in a report on a quantitative, observational study that compared the behaviour of nurses when they were exposed to either neutral or biased patient documentation. It’s embarrassing to me (a nurse) that the study found that biased language in documentation influenced how (un)helpful nurses were, and affected other aspects of clinical judgement and decision-making.

That’s a grim finding, isn’t it? It’s not just the unconscious cognitive bias of diagnostic overshadowing we have to watch out for. We have to watch out for letting that unconscious bias infiltrate our language in handover/documentation, so that we don’t inadvertently adversely affect the work of our colleagues too.

It’s easy to imagine diagnostic overshadowing (as per the excerpt above) leading to biased documentation, leading to a cascade of bias, resulting in empathy failure and poor outcomes for the patient.

That’s what my version of the distracted boyfriend meme is about.

It’s easy to be distracted from current problems, symptoms or pathology by biased documentation or past history.

Easy, but not cool.

Don’t be that guy.

References

Martin, K., Bickle, K. & Lok, J. (2022), Investigating the impact of cognitive bias in nursing documentation on decision-making and judgement. International Journal of Mental Health Nursing. doi.org/10.1111/inm.12997

Searby, A., Burr, D., James, R. & Maude, P. (2022), Service integration: The perspective of Australian alcohol and other drug (AOD) nurses. International Journal of Mental Health Nursing. doi.org/10.1111/inm.12998

End

That’s it. As always, please feel free to leave feedback via the comments section below.

Paul McNamara, 31 March 2022

Short URL: meta4RN.com/guy