Journal of Psychiatry

Abstract

The Effect of Hindsight Bias on Psychiatrists’ Clinical Judgment: A Randomized Controlled Trials

Mohammad Arbabi, Babak Mostafazadeh Davani, Majid Sadeghi Najafabadi, Ali Akbar Nejati Safa, Zaniar Ghazizadeh and Shakiba Javadi

Abstract Objectives: Hindsight bias is inevitable in retrospective peer reviews, especially in medical settings. Psychiatrists are highly at risk of hindsight bias, because of the repeated patient hospitalization and the use of medications with a lot of side effects. The goal of our study was to investigate the effect of hindsight bias on psychiatrists’ clinical judgment. Methods: We conducted our survey in 173 psychiatrists who participated in the congress of scientific society of psychiatrists in Iran in December 2010. A clinical vignette was presented to participants and they reviewed hypothetical cases in which patients with bipolar or psychotic features presented for psychiatric care. We informed two-thirds of the participants that a bipolar or psychotic feature accompanied patients’ symptoms (hindsight group) but withheld outcome information from the other participants (control group). Participants were asked to estimate the likelihood of each differential diagnosis. Results: Responses were compared between groups for suggestions of hindsight bias. The results indicate that hindsight bias plays a role in overestimating likelihood of psychotic disorder in these three groups (P value<0.05). Post-hoc analysis confirmed that this difference arises from difference in perceived probability of psychotic disorder without a significant difference in estimation of likelihood of mood disorder. Conclusion: Psychiatry just like other specialties is vulnerable to hindsight bias and its consequences, such as inappropriate treatments and unnecessary hospital admissions. Our results indicate that psychiatrist who was informed with psychotic disorders, which its misdiagnosis would result in more adverse outcome, would be more prone to hindsight bias.