Get-There-Itis (Plan Continuation Bias)

The Federal Aviation Authority (FAA) are well-aware of the dangers of Plan Continuation Bias:

“The continuation of an original plan even with the availability of new information that suggests that the plan should be abandoned or at least updated.” AKA Get-There-Itis.

Get-There-Itis has been the cause of multiple fatal air-accidents, where pilots have allowed stressors to bias their decision making, and fatally stick to a failing plan. But… these stressors effect everyone and clinicians are not immune!

Predisposing Factors:

  • Mission Imperative – Just get there
    • Make the referral
    • Clear the queue
    • Complete the task
  • Personal image
    • Competent – Can you admit you don’t know OR question seniors? (you may look stupid)
    • Confident – you’re better than average right? (only 50% of us are)
    • Safe – does admitting you were wrong make you unsafe?
  • Time pressure
    • Your shift ends soon
    • Lots more patients to see
  • Resources – its natural to stick with a diagnosis that’s easy to treat/refer
    • I can’t get that test
    • Referring to that speciality is hardwork
  • Health, relationships
    • I leave my problems at home…?


Get-There-Itis will have affected us ALL at various times, and we have ALL criticised others for it – Why Good Leaders Make Bad Decisions 

  • You only have 10mins before your shift ends, and the consultant asks you to see a patient with a straight forward plan.
    • Would you risk being late home and looking stupid by questioning the consultant?
  • A handover patient with a clear plan starts to deteriorate.
    • You’re busy and they have a plan – follow that??
  • Triage nurse tells you the patients here every day complaining of chest pain and needs to go home.
    • You can’t be that good if you can’t discharge the patient???


  • Confirmation”, and “desirability” biases
    • Seeing what we want to see – feels good.
    • Questioning ourselves – is uncomfortable.
  • Type 1 (reflex) thinking – it’s quicker, easier and feels better than Type 2 (computational) thinking.
  • Over-estimating knowledge, skills, and experience
    • ..clinicians…???


When the facts change, I change my mind. What do you do, sir?” J.M. Keynes

  • Treat a hypothesis
    • ED is a best guess
    • Admitting doubt allows you to change course
  • Be willing to accept; new, better or disproving data
    • Is the data agreeing for disagreeing with the proposed diagnosis?
    • Is the treatment working…?
  • Talk your problem through
    • Emergency Medicine is a team sport – colleagues can recognise what you may have missed
  • Recognize that any plan is immediately out of date and flawed.
    • Have Plan A, B, C…… and let people know
    • Use “all available information” to continually update (clinical and investigations)
  • Recognise the pressures you’re under and how that’s affecting your thinking
    • Expectations, time pressures, resource availability

Evidence: This works in the real world.

M. Christianson :Studied clinicians treating paediatric cardiac arrest, with faulty airway equipment (sims).

  • Performance was highly variable.
  • Fault recognission most frequently done by novices
  • Effective updating most commonly had more experts on team
  • Teams who found the fault were the ones who use most effective updating and listened to whole team

P. Tetlock: Studied the ability of individuals and groups (both professional and amateur) to predict movements in the financial markets

  • Performance was highly variable.
  • Amateurs often out performed professionals
  • Good performance “Superforcasters” correlated with those willing to question their theories and assimilate new data.

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