How Confirmation Bias Screws Up Assessment

I am not sure if we talk enough about confirmation bias and decision making.  You can see it in all kinds of decisions both in business and politics.  I just fell victim to it in a variety of ways. What you have to do is take this situation, and reprogram it into a business decision and see if the way you are putting a process into action reinforces confirmation bias or uncovers it.

Here is how it all happened.

If you read my blog, you know that I have been sick. I was just in the hospital for a couple of days and got discharged Tuesday, Jan 5th.

I want to say, all the staff and medical people I have interacted with during this whole process have been for the most part very very good.   Hospital food sucks but I digress.

I am 58 years old and 6’5″.  I am in relatively good health but frankly, this Covid year has crushed all the things I do regularly to stay fit.  I don’t weight lift anymore and have been very intermittent with yoga.  I don’t walk enough, and I put on some weight.  I was eating too much.  I got up to 245 from 230.  My diet is generally pretty good and I don’t smoke or do any drugs.  I do like wine and bourbon.  Like a lot of people I over imbibed in 2020 once Covid hit.  Anyway, at my age, things can start to go wrong.

In February, we had moved to Nevada and bought a house there in October.  In the summer we went to our lake place in Minnesota.  Nevada’s climate is very different than the Midwest.  Las Vegas hadn’t had rain since 2019.  It was really abnormally dry, even for an upland desert.

On Thanksgiving, I started feeling not good.  Every night, I would get a fever of 99-103, and when I went to bed I would sweat through two sets or one set of pajamas.  My fever was easily treated with Advil or Tylenol.  I chalked it up to a bad cold or some sort of flu. I had gotten a flu shot earlier in the year.  In 2018 I had bad flu and this was similar.  Back then, I was more tired, had far worse head and body aches, and was much more congested.  It could have also been Covid, but my wife had Covid and I didn’t get it.  I also had had a Covid like-cold in late January, or early February but had never been tested for immunity.

Go online and look at those symptoms and what pops up? Pneumonia.

I finally went to a quick test and my Covid test came up negative.  It was a test through my nose.

I recently moved to Las Vegas so I don’t have a doctor.  I finally had enough of it.  I was having trouble breathing.  Again, that points to Covid or Pneumonia, or worse, the combination of the two.

My first call in early December was to do telemedicine with my old doctor in Chicago.  He prescribed a round of two antibiotics based on what I had told him.   Based on the information he had, he certainly did the right thing.  They didn’t work.  I started feeling a lot worse.  I took them for only a few days.

I went to an urgent care clinic.  They took a chest x-ray.  The doctor told me I definitely had Covid Pneumonia.  He’d seen other x-rays like this and that’s what it was no debate about it.  I told the doctor two days ago I had a negative Covid test.  He said that everyone was wrong.  He’d seen enough chest x-rays and I had it but just to be sure, another test.  He had his own confirmation bias built-in based on his experience.  He was pattern matching.

Given the pandemic, and the economic incentives built-in for a positive Covid diagnosis, you cannot blame him for having confirmation bias.  The economic incentives are designed to make doctors and the health system more aggressive in seeking out Covid, but instead, have instilled confirmation bias into the system and they are missing other things.

He tested me in my mouth.  He prescribed prednisone and a short course of antibiotics because the test came back negative.   The doctor ignoring a test and being so sure it was Covid was his confirmation bias coming out.  1+1=2, no matter if there is a -1 in the equation.

My personal assumption was that I had bacterial pneumonia from wearing masks.  I never changed my mask much and I abhor them.  There were instances where people did get bacterial pneumonia from mask-wearing because bacteria from their mouths went into their lungs.

My own assumption was my own personal confirmation bias coming out.  I am not afraid of Covid.  I had a stream of three negative tests going back to October when my wife contracted Covid along with the other couple at an outdoor dinner party we were at.  I was the only one who didn’t get Covid so because of my Jan/Feb cold, I assumed I had antibodies.  I had been exposed to other people that had Covid but never got it.

I also detest the public policy around Covid.  It ignores all conditional probabilities and is destroying people’s lives.  That fed my personal confirmation bias.

Since this all went down in late February, we have been pretty isolated.  The only times I see other people are in big box stores.  Sure, I golfed with others but we were all in separate carts outside.  Covid doesn’t live outside.  In the summer, I saw 8 people at my daughter’s wedding.  We were mostly outside then too.

I took all the things the doctor prescribed but wasn’t any better.  On December 13, I went back to urgent care.  He looked at me again, and said we needed to go “elephant hunting”.  He gave me another Covid test, in my mouth.  I tested negative again.  He prescribed prednisone and Levaquin.  Levaquin is a powerful antibiotic and combined with prednisone, can have some nasty side effects like snapping your Achilles tendon.  The prednisone prescription was shorter than the Levaquin prescription by five days.

By December 23, I completed the round of antibiotics and was feeling okay.  Not 100%, but okay.  I could stay up past 9 PM and I wasn’t sweating or throwing fevers.  My O2 levels were low, but still above 90%.  I celebrated Christmas with my family, and on December 30th, I played a round of golf with my son in law.  I got a little out of breath but played my best round since moving out here. The new clubs were working.  The new grip on my putter gave me a better stroke.  Now if I could just drive the ball straighter, I’d score even lower.

On Friday, Jan 2 I threw a fever of 101 in the evening.  I took some Advil and it subsided.  During the night, I sweated a little but not huge.

On Saturday, Jan 3rd we decided that I go back to Urgent Care.  This time I had a different doctor.  We took a new chest x-ray and it looked exactly the same as my initial x-ray three weeks prior.  She said I had Covid Pneumonia even though I tested negative and said I needed to go to the hospital right away.

I stopped at a fast-food restaurant and drove directly to the hospital.  I didn’t pass Go, and I didn’t collect my $200.

Now you will see systemic confirmation bias continue.

I checked into the hospital.  They took a lot of blood for tests.  I got another Covid test, in my nose this time.  They gave me a CAT scan.  I went into an Ozone isolation room by myself to make sure I didn’t infect anyone else with Covid.   Everyone in the hospital treated me as if I had Covid.  Every nurse I spoke with about Covid told me they thought the public policies were overboard but they followed them anyway.  What politicians were doing to stop Covid wasn’t stopping Covid.

It turns out, an old trader buddy of mine had a similar thing earlier in the year.  He was hospitalized for a week.  He did a round of antibiotics all week and came out fine.  He didn’t have Covid.   That was my expectation for myself.

I was given some hyper strong antibiotics via IV round the clock.  Cefepime and Vancomycin.  They also took blood a lot to see that the antibiotics weren’t crushing my kidneys.  My O2 levels, heart rate, blood pressure were monitored around the clock.  I never had 02 levels above 92, but never really got below 90 while I was in the ozone room.  We were going to crush this infection with antibiotics.

My Covid test came back negative.  I ordered the doctor to give me an antibody test.  He was hesitant.  Remember, hospitals make more money for a Covid patient.  28 days after I left the hospital if I tested positive for Covid, they make extra money.  If I have antibodies, no cash.  He ordered the test, but it took a long time to come back unlike the Covid tests where the response was swift.

In the morning of Jan 4th, I was moved out of isolation into a room on a Covid free floor.

In the late-night on Jan 4th, I popped a fever, 99.5.  How can this be with all the antibiotics I was getting? My o2 levels were low, 87-88. The nurse left the room and did nothing.  At this point, I was frustrated.  I got out of bed and asked for Tylenol for the fever, and some oxygen.  After 30-40 minutes, I got the Tylenol, and the oxygen.  My fever went away, and my o2 went back up to 90.

I knew I didn’t have Covid, but I was finally a bit scared.  What if I had some weird viral pneumonia that was incurable?  The probability of me having quite a bit of trouble or even dying went up by a lot.  I knew it wasn’t cancer because the doctors told me it wasn’t and they would have found it in the CAT Scan.  It could be my heart because they hadn’t done anything to test that. What if this was really heart disease combined with something else?  That would be bad.

On January 5th, that antibody test came back negative.  I didn’t have Covid antibodies.  When that happened, I lost my confirmation bias.  My condition wasn’t from wearing masks.  It had to be something else.  What could it be?  I had never had pneumonia in my life.  This was both a scary and very frustrating moment.

It didn’t change my hospital doctor’s confirmation bias.  Nor did it change the nurses.  He wanted to do another Covid test which I refused to take.  More antibiotics were pumped into my system.

In the morning he came to visit me briefly on his rounds, and I face timed my wife into the conversation since due to Covid, she couldn’t visit me.  She had been actively searching the internet for answers and had a lot of questions.  My friend that had been in the hospital said you had to aggressively advocate for yourself due to Covid and other things and my wife was ready to do that.  I had only recently started to advocate for myself in the middle of the night with the request for Tylenol and Oxygen.

She asked the hospital doctor if I could see a Pulmonary doctor.  My doctor said yes, and pinged one right away.  He also ordered an ultrasound on my heart.

I received more antibiotics in the meantime.  My doctor didn’t change course on anything and wanted another Covid test which I refused to take.

Finally, around 10 AM on Jan 5th, the Pulmonary doctor came to visit me.  At the same time, another nurse was doing an ultrasound on my heart.  The ultrasound showed no problems with my heart.

The doctor said that I should not be upset with any doctor.  Given the pandemic, it is easy to understand why confirmation bias ruled each and every decision they made.  He complimented them on keeping extremely good records.

He’s been doing this in Las Vegas since 1978.  He’s seen a ton of different lung things and was considered one of the top docs.  When you research what Las Vegas is good at when it comes to health care, pulmonary medicine is the top. It’s one of the best places in the country for it.  Vegas is not great when it comes to other kinds of health care which was a concern when moving here.

The trial bar in Nevada is very strong. It’s one of the state’s weaknesses.

Because of this doctor’s experience, he was able to cut through the confirmation bias.  He was like the Devil’s Advocate in the old papacy.

He said he looked at my chest x-ray and said within five minutes he knew exactly what I had.  It was a very very very low grade of pulmonary fibrosis.  He told me not to Google it because then I would think I would be dead in three years.  That’s not the case with me.  It is very treatable and nothing to be extremely worried about.  I wished I would have gone to him in the very beginning, or that the doctors would have asked him to look in early December.

I asked if it could be Valley Fever, and he said he hadn’t considered it but when I saw him in his office in the next two weeks we could confirm or rule it out.  By the way, I had never heard of it but a friend that reads this blog tipped me off to it so I asked.  The symptoms are similar to what I had and given the extremely dry conditions in Nevada possible.  Plus, I had been out on the golf course a fair amount and when the wind blows, dust comes in from the surrounding desert and mountains.

If I have Valley Fever which is a fungal infection, the Prednisone will not be good for me.

The hospital doctor prescribed a blood thinner shot for me which I refused.  I hate needles, and I didn’t need that.  That shot is indicative of the legal ramifications surrounding medicine these days.  Overkill but fear of a lawsuit over blood clots.

The Pulmonary doctor prescribed Prednisone, and the hospital made me take a Pepcid AC with it.  I didn’t need the Pepcid, but they made me take it anyway.  Again, overkill.

I was finally discharged and came home.  Taking Prednisone has helped and feeling totally better with no antibiotics. Initially, I have a pretty big dose to calm things down, and then in all likelihood, the dosage will be reduced to next to nothing.

Confirmation bias by both me and my doctors cost me a lot of money.  I have a high deductible insurance policy, and there is no doubt I hit it.  It also cost me time.  Had I done the right things early, or the doctors did the right things right away, I would have not gone to the hospital and been on the right track in early December, not early January.

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