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Hindsight Bias Among Psychiatrists

Dr. LeBourgeois is Director, Forensic Psychiatry Fellowship Program and Assistant Professor of Psychiatry, Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA. Dr. Pinals is Director, Forensic Psychiatry Fellowship Program and Associate Professor of Psychiatry, Law and Psychiatry Program, and Ms. Williams is a Research Instructor, Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Dr. Appelbaum is Professor and Director, Division of Psychiatry, Law and Ethics, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY. Address correspondence to: H. W. LeBourgeois III, MD, Department of Psychiatry and Neurology, Tulane University School of Medicine, 1440 Canal Street, TB-53, 10th Floor, New Orleans, LA 70112. E-mail: hlebour{at}tulane.edu

It is crucial to minimize bias when offering forensic opinions; however, to our knowledge there are few, if any, existing data examining whether psychiatrists are susceptible to one source of such bias, hindsight bias. In the current study, 235 general and forensic psychiatrists reviewed hypothetical cases in which patients with suicidal or homicidal ideation presented for psychiatric care. We informed half of the participants that a suicide or homicide had occurred shortly after the patients were released from care (hindsight group) but withheld outcome information from the other participants (control group). Participants estimated the likelihood that suicide or violence would occur at the time of the patient's release and whether the standard of care had been met in each case. Responses were compared between groups for suggestions of hindsight bias. Results indicate that hindsight bias plays a role in assessments of risk, but not of negligence, and that psychiatrists who are American Academy of Psychiatry and the Law (AAPL) members may be less prone to respond with hindsight bias than are others.

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