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I enjoyed the challenge of Jason Carter’s case because of the complexity and common symptom often seen in primary care. I thought I did ok on history, but I missed quite a few pertinent questions, according to the experts. As I began to gather the subjective components, I found myself creating bi...

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  • March 23, 2022
  • 2
  • 2021/2022
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Jason Carter-I-Human
I enjoyed the challenge of Jason Carter’s case because of the complexity and common

symptom often seen in primary care. I thought I did ok on history, but I missed quite a few

pertinent questions, according to the experts. As I began to gather the subjective components, I

found myself creating bias. Jason had common symptoms associated with a heart failure

diagnosis, such as progressive dyspnea, orthopnea, and weight gain. Therefore, I started seeking

confirmation bias in the diagnostic reports. His physical exam was challenging because of some

of the signs I had never experienced in my nursing career.

I have never witnessed JVD or hepatojugular reflex, so I was glad the experts pointed it

out, but I wish they would have included Jason’s picture of his JVD. I was proud I identified the

S3 heart sound. Sometimes, the sounds are very challenging to hear, especially when they are

abnormal. However, his S3 was a very clear “gallop.” By the end of his physical exam, I had the

diagnosis of heart failure already in my head as the leading diagnosis, so I am guilty of

confirmation bias. I also found myself creating a “Semmelweis Reflex” bias with my omission

of differentials. For example, I selected pneumonia as a differential but already ruled out the

diagnosis because his symptoms did not fit the diagnosis.

I believe clinicians in various specialties are often guilty of the “job conditioning bias”

because of their extensive experience in one particular area. I would bet that any specialty-

trained clinician in cardiology would have made a heart failure diagnosis solely based on Jason’s

subjective components. However, the clinician must look at the entire clinical picture before

making a final diagnosis. There is a danger with creating any bias regardless of the condition

because of prolonged treatments ultimately affecting the patient’s health condition.

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