The Anchoring Effect in Assessment


On a cold February morning in 2018 I woke up around 5 am in a cloud of confusion. My arms and legs were tingling as if I had touched an electrical outlet and I felt insanely sick to my stomach. I look around for my husband but my eyes wouldn’t focus. What was happening? I remembered having similar symptoms when I had a few seizures in high school, but that was ten years ago.

“Mmm,” I yelled. I thought I was yelling my husband’s name but the words wouldn’t come out. Frantic I got up on wobbly legs and ascended down the stairs.

“John,” I yelled again. “Need hospital.” I couldn’t say anything more; those three words had taken all my strength.

A week later, I walked up the stairs of the parking garage of my local hospital for a neurology appointment in a complete haze. I had never felt so exhausted in my life, and I had two babies, I knew what exhaustion was. The neurologist’s office was a journey across the hospital. I remember walking in the door and feeling my heartbeat pounding in every inch of my body. I signed my name in at the front desk and before I could sit down to compose myself I was called back to a room. The nurse took my weight and put a pulse ox on my finger before taking my blood pressure. Her eyes were startled.

“Your heartrate is just a little high,” she said wide-eyed.

“Oh,” I replied breathless and fidgeting. I couldn’t calm my body and I was in a cold sweat. Was I nervous? This didn’t feel like nerves. Why wouldn’t my heart calm down?

“Um, I’ll be right back,” the nurse said before quickly exiting the room.

I remember wondering what could be wrong with me while taking four deep breathes to try and still my heart. It wouldn’t cooperate.

“How are you doing today?” the doctor said walking in the room with his eyes on me.

“Um, I’m a little nervous I guess. My heart is beating really fast and I’m exhausted.”

“Do you get those symptoms often?” the doctor began to type on his computer.

“Um, no. Not really. I mean, I guess I have anxiety but it doesn’t feel like this.”

“Okay, so tell me what brings you into my office today? I see you were at the ER last week,” the doctor replied.

I could only imagine what the notes said from the emergency room. My husband had told me I was babbling on about nightmares when I was finally able to talk that morning. I began to explain that I wondered if I had a seizure. I mentioned my prior history with seizures that had been witnessed, and began to list all of the symptoms that had occurred the week prior, but the doctor cut me off.

“This doesn’t sound like a seizure to me,” the doctor quickly replied. “Do you have trouble with anxiety?”

At first I was in shock. I knew from prior experience that the symptoms I experienced were textbook seizure symptoms. My eyes welled with tears. The combination of my high heart rate, emergency room babbles and admittance of prior anxiety had done me in. This doctor wasn’t listening to me. He then continued on about anxiety causing my high heartrate and possible fainting episodes.

“How could I faint in my sleep?” I asked, but he ignored my question.

As the doctor went on about whatever mental disorder he felt was the cause of my symptoms, I stood up with tears flowing from my eyes. I then walked out of the office. I knew I was proving his point of emotional instability by bursting out of his office in tears, but at the moment I didn’t care.

Looking back at this experience, I feel the neurologist/psychiatrist I saw that day had been taken hold by the anchoring effect. The anchoring effect is when a doctor’s judgement is clouded by their first impression of a patient’s problem and they are subsequently blinded to any other explanations (Gruman, Schneider & Coutts, 2017). Research in social psychology has shown that information gathered early on in an assessment can have a great impact on the understanding of the rest of the information obtained (Gruman et. al., 2017). In my case, the neurologist I saw had already read my emergency room notes and had talked to the nurse in the hallway before seeing me. This is when the anchor of his assessment of anxiety could have been placed. Though throughout our conversation I gave the doctor symptoms that were consistent with seizures and not anxiety (like electrical tingles everywhere and loss of speech or understanding), the doctor was unable to revise his first impression of anxiety due to the anchoring effect.

Instead of listening, the doctor took my high heartrate and fidgety symptoms as confirmation of his original assessment of anxiety by way of the confirmation bias. The confirmation bias is a part of the anchoring effect’s process. A confirmation bias is when physicians or clinicians look for symptoms that confirm their original assessment (Gruman et. al., 2017).

In the last two years since seeing that first neurologist/psychiatrist, I have been diagnosed with epilepsy by two neurologists and postural orthostatic tachycardia syndrome by a cardiologist (which is a disorder that causes high heartrate while standing). Though anxiety has been a part of my life throughout this process, as it is very scary to experience neurological symptoms at random, it was not the cause of my progressive neurological decline. This experience has made me very aware of the confirmation bias and anchoring effect that can occur in health care, and how imperative it is to advocate for myself. If I had listened to that physician that day, my diagnosis could have been prolonged further or even indefinitely.



Gruman, J.A.,Schneider, F.W., & Coutts, L.A. (2017). Applied Social Psychology: Understanding and Addressing Social and Practical Problems. Thousand Oaks, CA: Sage.



  1. These biases are real, and have real impact on individuals seeking care. I too have experienced anchoring effect by a physician, it can be frustrating to say the least. Research done by Saposnik, Redelmeier, Ruff, and Tobler (2016) discussed 16 different types of bias that they found in their article. This is including the anchoring effect you’ve discussed.

    In their results, the authors found: “Overconfidence, lower tolerance to risk, the anchoring effect, and information and availability biases were associated with diagnostic inaccuracies in 36.5 to 77 % of case-scenarios” (2016). There is a lot of work to be done it seems in educating clinicians of any potential bias they hold for the benefit of their clients and themselves.

    Saposnik, G., Redelmeier, D., Ruff, C. C., & Tobler, P. N. (2016). Cognitive biases associated with medical decisions: a systematic review. BMC medical informatics and decision making, 16(1), 138.

  2. This was terrifying to read, and I’m sure even more terrifying to live through! I’m sorry you had to experience this. I’m glad at least that in the end, you found neurologists and a cardiologist who actually took your symptoms seriously.

    You mentioned the anchoring effect; did you know that there is also evidence even today of gender bias when seeking medical care? Each year, clinic-based treatment expenditures for men are higher than expenditures for women with the exact same condition and severity (Hamberg, 2008). This implies that women are not believed about how severe their symptoms are as often as men are believed. Combined with the anchoring effect, it’s clear that there are likely many more patients out there whose symptoms have been dismissed as trivial when, in fact, they are indicative of something far more serious, as was the case with your own experience.

    Hamberg, K. (2008). Gender bias in medicine. Women’s Health, 4(3), 237-243.

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