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Personal Case Bias


This happened with me, it will happen with you, and has happened to your attendings. What am I talking about?

Personal case bias.

Let me explain.

I had a 25 year old female who came in to the clinic complaining of headaches and palpitations. Her only medical history included hypertension (which was seen at every visit – not episodic). Her symptoms per her history weren’t impressive by any means.

So, I decide to order 24 hour urine catecholamines and metanephrines.

Lo and behold – they’re elevated. She was then sent for CT and was given an urgent referral to endocrinology. She was diagnosed with pheocromocytoma.

Here’s the problem that comes with this diagnosis. We start to develop personal bias.

We start to think every patient who comes in complaining of headaches and palpitations might have a pheochromocytoma.

The reality is this is a very rare condition and odds are I’ll probably never diagnose another.

There are certainly indications to go looking for one – as in a patient who develops hypertension at an early age (i.e. 20-30 years). But, this doesn’t mean testing should be done every time a patient is coming in with episodic headaches and palpitations.

Cardiac arrhythmias, thyroid dysfunction, and anxiety are far more common.


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But, we’ve all done it. It’s hard to not let this affect your way of thinking.

After all, this is far more sexy and interesting than ….anxiety.

Remember to never sway from evidence based medicine. It is far more important to look at the data when ordering imaging, labs, etc.

Studies are done for a reason.

Don’t let one diagnosis (which might never occur again) change the way you manage your patients. Sure, you should use gestalt and experience, but don’t start fishing and/or shotgunning tests for these rare medical conditions.

Multiple studies, from which guidelines are derived from, look at far more patients than you will ever see in your career.

Rare diseases are, well, rare.

So, although I am happy I diagnosed this patient – I am well aware of what comes with this diagnosis.

So long as you don’t let personal case bias change you – you will be just fine.