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In reply: Hindsight bias in medicolegal expert reports

Thomas B Hugh and G Douglas Tracy
Med J Aust 2002; 176 (10): . || doi: 10.5694/j.1326-5377.2002.tb04535.x
Published online: 20 May 2002

In reply: We agree with Arnold that, ideally, expert witnesses should attempt to assess management decisions before acquainting themselves with the outcome and allegations in negligence cases. In practice, we suspect this is rarely done. In any case, the mere seeking of an expert opinion conveys the information that there has been an adverse outcome and, as we noted, there is evidence that, even if experts attempt to guard against it, hindsight bias is unavoidable in such circumstances. The central problem is that the expert is, as it were, looking back down one fork in the pathway of events, whereas the treating doctor was looking forwards at many possible and often uncertain forks.1




Correspondence: tbh35@hotmail.com

  • 1. Cook RI, Woods DD. Operating at the sharp end: the complexity of human error. In: Bogner MS, editor. Human error in medicine. New Jersey: Lawrence Erlbaum, 1994; 255-310.
  • 2. Working party of the NHMRC Standing Committee on quality of care and health outcomes. Clinical practice guidelines: diagnosis and management of unstable angina. Canberra: National Health and Medical Research Council, 1996.
  • 3. Eslick GD, Talley NJ. Non-cardiac chest pain: squeezing the life out of the Australian healthcare system? Med J Aust 2000; 173: 233-234.

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