Discussing the Role of Clinical Biases in Diagnosis

The following essay will attempt to offer a considered and balanced review of the role of clinical biases in diagnosis. Clinical diagnosis refers to a process that matches an individual’s specific symptoms to those that define a particular mental disorder. Clinical biases refers to behaviours that psychologist unconsciously have, these may be both beneficial and dangerous. Biases occur when researchers experience preconceived ideas about the likelihood of a disorder, based on the social and cultural background of the patient.

Most psychological disorders are diagnosed on the basis of clinical symptoms. Psychological disorders though, are highly subjective to biases of the psychiatrist and thus may result in a problem with the diagnosis. Clinical biases may result because of diverse reasons. Cross- cultural variations for example. Different cultures may consider different behaviours as normal or “abnormal” therefore a psychologist may interpret behaviours differently based on the cultural background they grew up with. Duncan Double (2006) argues the frequent occurrence of over diagnosis in diagnosing psychological disorders. Thus occurs when patients suggest themselves a disorder which they might suffer… The doctor, lacking evidence for a diagnosis ‘fulfils’ the patient’s want by over-diagnosing. This diagnostic bias tends to happen when the symptoms in the patients are unexplained. Another known clinical bias is the confirmation bias. Thus occurs when a psychologist seeks, interprets and remembers information so that it confirms their preconceptions. This leads the researcher to weight more evidence that supports his/hers hypothesis and disregard evidence that denies it.

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The study conducted by Mendel et al in 2011 aimed to see if psychologists would show confirmation bias when making a diagnosis. The researcher used purposive sampling and tested 75 psychiatrists and 75 medical students. All participants were given a summary of a case study that focused on an elderly man who suffered from Alzheimers. Though the man originally suffered from Alzheimer’s disease, the summary of the case study made it seem as most probable that he suffered from depression. After reading the case study, all participants were allowed to conduct further research. Results showed that 13% of the psychiatrists and 25% of the medical students misdiagnosed the individual due to the preconception they had on the diagnosis. This study concluded that clinicians are subjected to confirmation biases and therefore their diagnosis may be influenced by their conceptions of an individuals attitudes. The study conducted by Mendel provides insightful knowledge on regards to studying social groups and the study was able to analyse participants behaviour without them knowing it was an investigation (reducing participant bias). On the other hand, the study conducted by Mendel shows some limitation as confirmation bias is a very subjective thing, that changes from person to person, affecting people in a different manner. Thus would affect the generalisability of the data gathered from the investigation. Clinicians who diagnosed the elderly man with depression suggested and prescribed wrong treatments endangering the individual, therefore this study shows how confirmation bias can lead to harmful and dangerous diagnosis.

The study conducted by Rosenhan et al in 1973, aimed to challenge the validity and the reliability of clinical diagnosis and to investigate the effects of patients labelling their own disorders. Again, purposive sampling was used in this investigation as the researcher specifically selected 5 males and 3 female figures. All 8 participants tried being admitted into the hospital’s psych ward. Participants called the hospital and set up diagnosis appointments. They were all admitted into the psychiatric ward with diagnosed schizophrenia. When admitted into the ward, participants stopped ‘manifesting’ symptoms and acted ordinarily. All participants took notes regarding the way people treated them. The study concluded that no staff member ever suspected of their sanity, although other patients in the ward did. The staff members also labeled the notes which the participants had taken as an “abnormal” behaviour. The study conducted by Rosenhan shows over diagnosis of the psychiatrists. The study has numerous strengths as it clearly demonstrates how patients ideals may influence clinicians and their diagnosis, however again, it shows some limitation as participants were not kept in a stable/safe environment. Participants in fact, after the experiment, had trouble convincing psychiatrists that it was an investigation and that they were mentally “sane.” The study conducted by Rosehan shows that everyone has a different vision regarding what is to be considered sane and what is to be considered insane. The behaviour of the participants was misunderstood and misinterpreted and thus led to patients being hospitalised being powerless, segregated and self-labeled. This was counter-therapeutic. The study conducted by Rosehan shows that clinical bias may be influenced by individuals and may lead to fallacies in diagnosis which cause dangerous treatment.

Overall, though both the studies conducted by Mendel and Rosehahn show some limitations, they provide more strengths and insight into how clinical biases may affect diagnosis. Mendel’s study shows confirmation bias, were the researcher seeks to prove his original hypothesis in the diagnosis. Reshahn’s study shows over diagnosis, were the patients self - labeled disorder ‘manipulates’ the psychologists thoughts leading him to a bias diagnosis. As shown through both studies, clinical biases are extremely dangerous as they can lead to wrong treatments and prescriptions that can be fatal.