Gout or Deep Vein Thrombosis: Expanding Differential Diagnosis and Avoiding Anchoring Bias

Abstract

Diagnostic reasoning is a critical skill for a nurse practitioner. Cognitive biases influence nurse practitioner decision making, and anchoring bias is the most common cognitive error. Cognitive error is a systematic deviation from optimal decision making or errors in thinking from reliance on mental shortcuts known as heuristics. Anchoring bias is when initial information dominates decision making, neglecting alternative diagnoses. This case describes a patient with pain, redness, and swelling in the left ankle, attributing it to a gout flare-up. To avoid anchoring on this diagnosis, reflective practice considered alternatives such as deep vein thrombosis. Reflective practice involves examining one’s experiences and adopting a critical perspective toward one’s own methods and practice. The patient was referred to the emergency department where a diagnosis of deep vein thrombosis was confirmed. This case underscores the importance of acknowledging cognitive biases and implementing debiasing strategies.