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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / McDonald, Kathryn / Singh, Hardeep

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Blinding or information control in diagnosis: could it reduce errors in clinical decision-making?

Joseph J. Lockhart
  • Corresponding author
  • Consulting Psychologist, Forensic Services Division, Department of State Hospitals, State of California, Suite 410, Sacramento, CA 95814, USA
  • Email
  • Other articles by this author:
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/ Saty Satya-Murti
Published Online: 2018-09-19 | DOI: https://doi.org/10.1515/dx-2018-0030



Clinical medicine has long recognized the potential for cognitive bias in the development of new treatments, and in response developed a tradition of blinding both clinicians and patients to address this specific concern. Although cognitive biases have been shown to exist which impact the accuracy of clinical diagnosis, blinding the diagnostician to potentially misleading information has received little attention as a possible solution. Recently, within the forensic sciences, the control of contextual information (i.e. information apart from the objective test results) has been studied as a technique to reduce errors. We consider the applicability of this technique to clinical medicine.


This article briefly describes the empirical research examining cognitive biases arising from context which impact clinical diagnosis. We then review the recent awakening of forensic sciences to the serious effects of misleading information. Comparing the approaches, we discuss whether blinding to contextual information might (and in what circumstances) reduce clinical errors.

Summary and outlook

Substantial research indicates contextual information plays a significant role in diagnostic error and conclusions across several medical specialties. The forensic sciences may provide a useful model for the control of potentially misleading information in diagnosis. A conceptual analog of the forensic blinding process (the “agnostic” first reading) may be applicable to diagnostic investigations such as imaging, microscopic tissue examinations and waveform recognition. An “agnostic” approach, where the first reading occurs with minimal clinical referral information, but is followed by incorporation of the clinical history and reinterpretation, has the potential to reduce errors.

Keywords: blinding; cognitive bias; diagnostic error; forensic medicine; forensic psychology


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About the article

Corresponding author: Joseph J. Lockhart, PhD, ABPP, Consulting Psychologist, Forensic Services Division, Department of State Hospitals, State of California, Suite 410, Sacramento, CA 95814, USA, Phone: +916-616-1465

Received: 2018-05-26

Accepted: 2018-08-21

Published Online: 2018-09-19

Published in Print: 2018-11-27

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Citation Information: Diagnosis, Volume 5, Issue 4, Pages 179–189, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2018-0030.

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