Nautically speaking, “anchors aweigh” is the command that is used when an anchor is to be hoisted from the ocean’s floor. Conversely, “Anchoring,” in medicalese is known as “confirmation bias,” and occurs when the physician’s radar points to the obvious or expected diagnosis. Instead of having a differential list with multiple possibilities the physician quickly and firmly latches on to a single diagnosis, thus “throwing the anchor down.” Anchoring can be a deceptive selection process or shortcut that accepts/ignores information that may obscure the physician’s diagnostic vision. “You look at your mental map but your mind plays tricks on you (confirmation bias) because you see only the landmarks you expect to see and neglect those that should tell you that in fact you’re still at sea” (How Doctors Think, Jerome Groopman, M.D., 2007, p. 65).

During normal decision making, individuals anchor or overly rely on specific information or a specific value and then adjust to that value to account for other elements of the circumstance. Usually once the anchor is set; there is a bias toward that end result and rationalization of the “red flags” may ensue. A simple strategy to safeguard against anchoring too quickly would be to generate a short differential list which could include surrounding organs. Another strategy would be to ask yourself, “What is the worst thing that this could be?” When considering a diagnosis it is important that the physician and patient are on the same wavelength. For example, when a patient reveals that they took a few aspirin, a prudent question would be, “How many is a few?” It could make the difference between a correct or incorrect diagnosis. Consider the differences in the following two case studies:

1. A patient comes into the office complaining of ankle pain after falling. An x-ray confirms an ankle fracture and care is focused around the fracture. The anchor was thrown down with the obvious diagnosis. The root of the fall, however, was not explored as the anchor was sinking. Why did this patient fall? Did he trip? Did he become dizzy? Does he have an arrhythmia? In this case, the patient became weak due to anemia caused by colon cancer.

2. A patient presents with acute flank pain and hematuria. It is likely that the patient would be diagnosed and treated for a kidney stone. The physician in this case study had learned to ask himself the aforementioned crucial question, “What is the worst thing that this could be?” In this case, the patient was experiencing a dissecting aortic aneurysm.

As seen in these case studies, a thorough history, good listening skills, and an arsenal of open ended questions can help to delve below the surface of a seemingly obvious diagnosis. The concepts of this article were taken from a book entitled, “How Doctor’s Think,” authored by Jerome Groopman, M. D. Dr. Groopman concludes by saying, “....For three decades practicing as a physician, I looked to traditional sources to assist me in my thinking about my patients: textbooks and medical journals; mentors and colleagues with deeper or more varied clinical experience; students and residents who posed challenging questions. But after writing this book, I realized that I can have another vital partner who helps improve my thinking, a partner who may, with a few pertinent and focused questions, protect me from the cascade of cognitive pitfalls that cause misguided care. That partner is present in the moment when flesh-and –blood decision-making occurs. That partner is my patient or her family member or friend who seeks to know what is in my mind, how I am thinking. And by opening my mind I can more clearly recognize its reach and its limits, its understanding of my patient’s physical problems and emotional needs. There is no better way to care for those who need my caring.” (How Doctors Think, Jerome Groopman, M.D., 2007, p.268-269).