Cognitive bias, not racial bias, led to Indigenous patient’s misdiagnosis: coroner
Cognitive rather than racial bias led an emergency physician to misdiagnose a 36-year-old Indigenous man with cannabinoid hyperemesis syndrome, a coroner has found.
The doctor is being referred to the NSW Health Care Complaints Commission over his treatment of Ricky “Dougie” Hampson, who died of two perforated duodenal ulcers back in 2021.
The Kamilaroi-Dunghutti man presented to Dubbo Base Hospital after feeling a “pop” in his abdomen, despite being reluctant to seek medical care.
“The very fact that Dougie [Hampson] self-presented at the hospital was very significant and further supported the fact that he was very unwell at the time of presentation,” Deputy State Coroner Erin Kennedy said in her findings.
Per an RMO’s notes, Mr Hampson was tachycardic, had described his pain as 10 out of 10, and reported smoking cannabis that morning.
The RMO discussed the presentation with the ED consultant, who “quickly” diagnosed cannabinoid hyperemesis syndrome (CHS), the coroner said.
Mr Hampson was administered an antiemetic, analgesia and fluids, spending the night in the ED short stay unit.
He was found dead the morning after he was discharged.
The ED doctor told the inquest that he had not seen the triage notes, which referred to the popping noise, or the RMO’s notes, which said Mr Hampson was Aboriginal.
He said the quick diagnosis was influenced by the “waves” of CHS cases at the hospital, and appeared to be confirmed by bloods showing loss of potassium and sodium.
But he accepted that cognitive bias had “anchored” his diagnosis of CHS, even without the hallmark symptoms of nausea and vomiting.
He did not know that Mr Hampson had identified as Aboriginal when he made the initial diagnosis, the coroner said.
“There were no findings from the evidence that there was any conscious or unconscious racial bias in relation to the treatment,” she found.
However, after the findings were handed down, Mr Hampson’s father said that “hospitals and doctors keep using fancy words to describe racism — ‘cognitive bias, anchoring bias, early diagnostic closure, colour blind bias’”.
“They can use whatever term they want — at the end of the day, it means blackfellas get killed in the health system — and that’s racism.”
He said it was part of the reason that Indigenous Australians were reluctant to seek medical care.
“A lot of blackfellas don’t normally go to the hospital, because of the track record of the health system in this country,” he said.
“We are scared to go to hospitals. Our fear is real.
“Just look at what happened to our beloved son.”
Read more: Doctor says ‘cognitive bias’ behind failed diagnosis of Indigenous patient’s perforated ulcers
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