Maya is a hardworking and enthusiast intern in a psychiatry clinic. She is planning to be a psychiatrist in future so she joined this clinic especially to pursue her interest and fascination with human brain and its functioning. As part of her rotation she assisted the psychiatrist and took the notes. One time her supervisor introduced her to a patient and asked to take history and do the assessment. The patient was referred from his primary care physician for possible bipolar with depression. Maya was really thrilled to have an independent case and worked thoroughly with the guidelines. After the interview she had three differential diagnoses and after ruling out two, she made her final diagnoses. There was no doubt of errors and she was pretty confident about it. When she presented the case, the psychiatrist as well as psychologist smiled. The patients was having a medical illness with some physical signs similar to depression and going through situational stress, anxiety and depression. The patient clearly did not qualify for mental illness; Maya could have diagnosed this correctly if it was not psychiatry clinic and had she not seen the referral order from PCP with presumptive diagnoses. These things had affected her decision about the diagnoses.
Since then she has learned a lot from this rotation, including a newer non-invasive treatment modality for depression. This has shown promising results in past clinical trials and got recently approved by FDA for depression. This has minimal sided effects as compare of conventional treatment modalities. As part of the consulting team she was actively engaged in recruiting the patients for this treatment and then following up on their condition. She had hard time in convincing chronic patients though they had never reached to remission with meds and chances were high to get benefit from this but they did not want to go for this treatment and were comfortable to continue even without much benefit. They would bring lots of issues for not agreeing to this treatment until she arranged a patient’s meet in the clinic on a Friday evening. It was a way to bring all the patients together who were getting the treatment as well as share the experience with ones who might be interested. It was a successful evening and since became norm for the practice to have patient’s meet once a month with evening snack. More and more people got involved, patients from outside practice, well-wishers of the patients and finally those who were hesitant early. Maya did a retrospective analysis of the patient who got the treatment and was happy to see the amazing results. This was presented in a seminar and published, since then patient awareness has increased tremendously.

Case Study Analysis
Model:
A practical decision making framework with hidden biases to address the challenges a medical student faced in clinical setting. The hidden biases can affect the professional competencies. Successful problem solving is dependent on the quality of decisions made along the way.
Data:
The Anchoring Trap: Maya looked on to diagnoses too early and failed to adjust to new information. The referral letter from PCP with presumptive diagnosis leads to anchoring and she got biased to diagnose a mental disorder because this was a psychiatry clinic.
The Status-Quo Trap: The chronic patients in the clinic were hesitant to start the newer alternative treatment. They find status quo comfortable and had avoided to taking action that would upset it.
The Sunk-Cost Trap: Patients continued to take older treatments, though it no longer seems to help them.
The Confirming-Evidence Trap: Most of the patients who were interested in newer modalities were influenced by the monthly meet and convinced by the other patients who already got the treatment.
Analysis:
Anchoring is a thinking trap in which our thoughts get anchored to our first impression and then the search for a diagnosis is overly influenced by that impression. It is adopting a new clinical process, designing a new product, or managing one's portfolio of mutual funds, it is very difficult to break away from the seemingly magnetic pull of the status quo. Maintaining the status quo is comfortable and requires no further action. Breaking away and taking a different course of action requires decision making, uncertainty, doubt, and renewed responsibility. As a consequence, it is easy to find reasons to do nothing; doing nothing and remaining silent puts individuals at less psychological risk (Hammond, Keeney, and Raiffa 1998).
The Status-Quo Trap influences the choice we make. It is an inherent part of our thinking and subconsciously, we are self-protective and risk-aversive.
The confirming evidence trap affect the where we go to collect evidence as well as how we interpret it. We give too much importance to supporting and too little to conflicting information.
Take Away:
To avoid these pitfalls in decision making, be always be open minded, think about the problem on your own before consulting to others to avoid becoming anchored to their ideas.