Question
What is the impact of bias on clinical assessment for dysphagia?
Answer
Anchoring bias occurs when clinicians rely excessively on the first piece of information they observe, potentially distorting their overall evaluation. For instance, if a clinician observes a patient coughing during an initial swallowing trial, they may fixate on this as evidence of dysphagia. This initial observation might overshadow subsequent clinical findings, even if later trials demonstrate no further signs of swallowing dysfunction. Conversely, a single instance of coughing at the end of an otherwise normal assessment might be dismissed as insignificant, highlighting how anchoring can skew decision-making. Awareness of this bias is essential to ensure that clinical judgments are based on the entirety of evidence rather than a single observation.
Confirmation bias leads clinicians to selectively focus on information that aligns with their preexisting assumptions. For example, upon seeing right lower lobe pneumonia in a patient’s chart, a clinician might prematurely conclude that it is aspiration-related. Subsequent observations, such as coughing or throat clearing, may then be interpreted as further confirmation of aspiration, even when alternative explanations exist. This bias can result in overdiagnosis or misdiagnosis, underscoring the importance of maintaining objectivity and considering a broad range of possible causes in clinical assessments.
This Ask the Expert is an edited excerpt from the course, Medically Complex Decision-Making for the SLP, presented by George Barnes, MS, CCC-SLP.