11/21/2016 06:49 EST | Updated 11/21/2016 06:49 EST

How Did Journalists Fail To Diagnose A Trump Win?

President-elect Donald Trump gives the thumbs up as he arrives at the Trump National Golf Club Bedminster clubhouse, Sunday, Nov. 20, 2016 in Bedminster, N.J.. (AP Photo/Carolyn Kaster)

It might have been his Boston Red Sox baseball cap, his hybrid car, or his kindness towards me as a female first generation immigrant, but after speaking with Victor T from Tucson, Arizona, for an article about election stress, I felt pretty confident he would vote for Hillary Clinton.

Yet, while Victor described himself as an "undecided" voter, and that Clinton "seemed nice," he supported Donald Trump's immigration stance, refused to disclose his surname, and told me his cap was a gift from his New England cousin. In hindsight, these latter facts paint a very different picture of a resident of a State that would go on to grant Trump 49.5 per cent of the popular vote -- a full four percentage points over Clinton.

After the election results were announced, I felt a pit in my stomach -- the one physicians recognize when their team misses something crucial in medical diagnoses. As a new journalist myself, it seemed familiar. It brought me back to the day an attending physician described how he missed antifreeze poisoning in a toddler, as it looked remarkably like the more common diagnosis of "sepsis" (severe infection). The toddler died, as the team overlooked crucial information in the lab tests -- particularly the child's blood pH.

There's a well-known adage in medical training: "When you hear hooves, think horses, not zebras." It is intended to guide trainees to understand that "common things are common;" to help prevent over-emphasizing rare causes of disease. However, this can fuel cognitive bias in physicians.

The world experienced its own zebra in Donald Trump -- a candidate as insidious as to be compared to a cancer. Or rather, he is a "dark horse," the term used to refer to the unexpected rise of an underdog in politics -- someone that seems to 'come out of nowhere' to emerge victorious.

Abraham Lincoln was a dark horse. So was Adolf Hitler. As both medicine and journalism are fields that rely as heavily on stories as they do on the objectivity of the listener, many physicians can sympathize with the journalists accused of bias in reporting of the recent US election. Journalists may benefit from "cognitive de-biasing" strategies used in medicine.

Indeed, journalists have been accused of failing to represent the deep anger and mistrust of Americans in small towns, underestimating (and underreporting) the momentum of the 'silent majority' of Trump voters, being overly-reliant on polls, and failing to engage Trump voters who were essentially hidden in plain sight. This was compounded with suggestions of harm resulting from social media algorithms and the idea that many journalists may lean liberal.

So now that there has been a call to action towards re-invigorating journalism, and for more dutiful reporting, by addressing inherent biases, reporters can get closer to the purpose of journalism: a more honest version of truth.

Dr. Pat Croskerry, a Canadian emergency physician who studies cognitive error in medicine has identified a number of biases that doctors fall into, which can lead to misdiagnoses. Croskerry suggests that a process of "deliberate uncoupling" of intuitive tendencies, particularly through specific "cognitive de-biasing" strategies aimed at physicians. I believe these could be easily applicable to journalists.

The first common bias that affects journalists is availability bias: the tendency to judge the likelihood of an outcome (a disease or an election) based on what most easily comes to mind. So, for instance, Obama's historical win over the last two elections might be fresh in a young journalist's mind. So too can the diagnosis of asthma in a child -- if the physician previously saw eight cases of the same.

A second bias is anchoring bias -- i.e. failing to adjust one's original position or perception once new info is known. For instance, while polls were subject to systematic error, inherent biases related to low voter turnout, and the bandwagon effect among Democrats, journalists didn't question polls that confirmed what they had hoped. In medicine, physicians might find themselves searching for diagnostic results that could verify a diagnosis, and ignore lab values that might discredit their hypothesis.

The third bias is representativeness error -- when one's thinking is heavily influenced by what is typically true. For instance, in the case I previously described, a child may be more likely to suffer from sepsis than antifreeze poisoning -- the latter may be less commonly seen in hospitals. Similarly, in my assessment of Victor: Red Sox fans are often from Boston, a city that typically leans left.

To combat these biases, Croskerry suggests several things which I believe can be applied to journalism. For instance, journalists could learn about biases early on in their training, actively consider less plausible outcomes in politics, seek a variety of opinions in their reporting, and improve personal accountability around their stories. Similar to hospitals, editors may even decide to incorporate checklists. This might include items around checking that reporters have adequately obtained information from both sides, evaluated the data appropriately and objectively, and reflected on how their own political leanings may affect a story.

In medicine - "red flags" are those that lead doctors to dismiss the common and benign for something dire and possibly deadly. On November 8th we saw these red flags quite literally pop up across the nation as Trump won several key states. As we fall short of having a Hippocratic Oath in journalism as we have in medicine, we can use current calls to action to be fearless in reporting and addressing our collective biases for the benefit of accurate journalism.

As the late Gwen Ifill said "my job as a reporter is not to know what I think." Indeed part of it may be to evaluate "how" journalists think.

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