Setting: Emergency department with four characters
Claire Jones – patient: (somewhat somber) I could have died. The doctors tell me I'm very lucky to be alive. I still can't use my right arm properly and I sometimes have trouble finding my words, but I'm a lot better.
I've been having headaches and migraines since I was a teenager. I really didn't want to go into the emergency that day but I don't have a family doctor so I have to wait in emergency every time I need more pills.
It was midday and I was at work with a lot on my plate. But the headache was killing me and I knew that I had run out of medication. It was the worst headache I'd ever had. It came on so suddenly.
Dianne Lemieux – ED triage nurse: (sympathetic tone) I'd seen her in emerg a few times before. Poor girl, recurring migraines, pain 10 on 10, wasn't improving on its own. She waits for hours sometimes just for a refill of her meds. I tried to grab someone for her so she could be on her way sooner.
Dr. Jenny Locke – 1st year resident (seems distraught) Dianne grabbed me to see Mrs. Jones. She told me Mrs. Jones was a regular here at emerg for her frequent migraines. I didn't do much of a history. Her medical record is full of similar visits. I think she said her pain was similar to some of her previous episodes.
Dr. Nollan had filled out her last script. She seemed to have responded well to the migraine meds and wanted a refill. I didn't see a problem, so I made her a new refill and I sent her on her way.
Dr. Jack Nollan – ED staff physician: (somewhat defensive) I knew this patient, I'd seen her before. She has a family history of migraines, and she's suffered from them for about 10 years.
Ms. Jones seemed alert and oriented when I passed by her in the waiting room, so I trusted the resident to take care of it.
I mean, who would've thought that this time it was actually a subarachnoid hemorrhage?
Concluding facilitation question: What factors, including cognitive biases, might have affected the diagnostic process for this patient?