Formalizing cognitive biases in medical diagnostic reasoning

This paper presents preliminary work on the formalization of three prominent cognitive biases in the diagnostic reasoning process over epileptic seizures, psychogenic seizures and syncopes. Diagnostic reasoning is understood as iterative exploration of medical evidence. This exploration is represented as a partially observable Markov decision process where the state (i.e., the correct diagnosis) is uncertain. Observation likelihoods and belief updates are computed using a Bayesian network which defines the interrelation between medical risk factors, diagnoses and potential findings. The decision problem is solved via partially observable upper confidence bounds for trees in Monte-Carlo planning. We compute a biased diagnostic exploration policy by altering the generated state transition, observation and reward during look ahead simulations. The resulting diagnostic policies reproduce reasoning errors which have only been described informally in the medical literature. We plan to use this formal representation in the future to inversely detect and classify biased reasoning in actual diagnostic trajectories obtained from physicians.