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.
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.
