Framing bias: a case for rectorragia



In a morning during a hand-off in a hospital the doctor leaving after duty passed  the information to the next doctor about a 72-year-old patient with rectorragia. The second doctor was only aware about the hemoglobin level and he indicates a transfusion, but the patient continued with rectorragia with a dark-red colour…

Because the patient was very sick and with a continuous bleeding a consultation to a gastroenterology was made. She started again the anamnesis and the patient referred nausea and vomiting. A gastric tube was inserted and and active bleeding was detected. An endoscopy showed a big ulcer in the duodenum as the origin of the bleeding.

COMMENTS: The way the information was transmited to the other doctor set his mind in the colon or rectum as the origin of the bleeding because the color of the blood was dark-red and not with the typical dark-black color of melena that suggests a gastric origin.

Sometimes, when the color of the feces is red the origin of the blood can be located  in the stomach and this happens when the transit is very fast . In this case the red color and the way the information was exposed during the hand-off “framed” the initial thoughts of the first doctor in terms of the colon as the location of the bleeding.

The framing effect is a cognitive  bias that refers to the tendency for our responses to be influenced by the way a problem or question is presented.