Monday, March 20, 2017

Cognitive Bias, Clinical Practice and Hospital Epidemiology: We Need to Stay Open Minded and Nimble

Lately I have been thinking a lot about by bias in medical practice. A recent article on cognitive bias, published in The Pharos, neatly explores this concept. Bias can be pervasive in clinical care. The good news is that unconscious bias need not be permanent. Bias can be changed by intention, attention and reflection.  

              
Bias in medicine also spills over to infection prevention. In the book Pandemic, by Sonia Shah, the concept of paradigms in medicine is explored.   Paradigms are theoretical constructs that provide explanatory frameworks for scientific observations. However, paradigms create expectations which can limit perceptions and lead to confirmation bias and change blindness.

In many ways, we take a paradigmatic approach to the use of contact precautions, particularly for endemic pathogens.  Contact precautions are of unproven benefit and, at best, a low-value intervention that requires significant personnel engagement. This has been challenged recently, as published here. More recently, Widmer and colleagues have demonstrated that C. difficile can be controlled without the use of contact precautions, as summarized in this publication.

In the absence of high quality data, we should not be too dogmatic and biased about any infection prevention strategy.  We need to remain open mind and nimble, especially in the face of new data.

I will discuss this topic, with respect to controlling C.difficile, at the upcoming SHEA Spring 2017 meeting, in a plenary session with my colleagues Dr. Michael Edmond (University of Iowa) and Sivia Munoz-Price (University of Wisconsin).

Looking forward to it 


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