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• W4230054219 abstract "Cognitive biases frequently result in diagnostic inaccuracies and medical mismanagement, resulting in adverse outcomes or inadequate use of resources. In June, 2017, an African-American man aged 64 years presented to our emergency room from prison, accompanied by three security guards, with a chief complaint of altered mental status, confusion, and lethargy. The man had a medical history of systolic congestive heart failure and had previously been fitted with a dual-chamber implantable cardioverter defibrillator. Pertinent history was obtained by the guards, who stated that the patient might have ingested ketamine or a synthetic cannabinoid. Physical examination showed that the patient was afebrile, haemodynamically stable, lethargic (with a Glasgow Coma Scale score of 10), unable to follow commands, and jaundiced with scleral icterus, with no other notable physical findings. Laboratory investigations showed noteworthy increased total bilirubin and ammonia concentrations, and a leucocytosis with bandaemia. The urine drug screen was negative and his abdominal ultrasound was normal. He was admitted to our medical intensive care unit for presumed drug intoxication and hepatic encephalopathy, and supportive care was initiated with intravenous fluids and lactulose. The patient's mental status continued to deteriorate despite supportive care, and the decision was made to proceed with endotracheal intubation and lumbar puncture. An uncomplicated lumbar puncture yielded yellow cerebrospinal fluid that was sent for analysis. The results showed noteworthy increased proteins (1052 mg/dL) and white blood cells (1978 cells per μL, with predominant neutrophils), and low glucose (<35 mg/dL). Although the cerebrospinal fluid gram stain and culture were normal, the patient's blood cultures were positive for Streptococcus pneumoniae. A diagnosis of streptococcal meningitis was made and appropriate antimicrobial therapy and dexamethasone was initiated. Thereafter, the patient's mental status and overall health improved and he was discharged. Anchoring is a cognitive bias that describes the reliance of human beings on the first piece of information offered (ie, the anchor) when making decisions. Once an anchor is set, there is a bias toward interpreting other information around the anchor. In this case, we anchored on unverified information that the patient had ingested a mood-altering or mind-altering substance. This anchoring caused a delay in the diagnosis and management of a life-threatening meningitis. This case is a reminder that physicians should diligently and objectively question and test their diagnoses as new information presents itself. We declare no competing interests." @default.
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• W4230054219 date "2017-09-01" @default.
• W4230054219 modified "2023-09-28" @default.
• W4230054219 title "Anchors aweigh" @default.
• W4230054219 doi "https://doi.org/10.1016/s0140-6736(17)32139-6" @default.
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