The Importance Of Cognitive Errors In Diagnosis And Strategies To Minimize Them Pdf

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Diagnostic Error in Internal Medicine. Arch Intern Med.

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Diagnostic error, overconfidence and self-knowledge

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Diagnostic Error in Internal Medicine

Medical error is a leading cause of death nationwide. While systems issues have been closely investigated as a contributor to error, little is known about the cognitive factors that contribute to diagnostic error in an emergency department ED environment. Eight months of patient revisits within 72 h where patients were admitted on their second visit were examined. Fifty-two cases of confirmed error were identified and classified using a modified version of the Australian Patient Safety Foundation classification system for medical errors by a group of trained physicians. Despite the complex nature of diagnostic reasoning, cognitive errors of information processing appear to occur at higher rates than other errors, and in a similar pattern to an internal medicine service despite a different clinical environment. Further research is needed to elucidate why these errors occur and how to mitigate them.

Confirmation bias is the tendency to search for, interpret, favor, and recall information in a way that confirms or supports one's prior beliefs or values. The effect is strongest for desired outcomes, for emotionally charged issues, and for deeply entrenched beliefs. Confirmation bias cannot be eliminated entirely, but it can be managed, for example, by education and training in critical thinking skills. Confirmation bias is a broad construct covering a number of explanations. Biased search for information, biased interpretation of this information, and biased memory recall, have been invoked to explain four specific effects: 1 attitude polarization when a disagreement becomes more extreme even though the different parties are exposed to the same evidence ; 2 belief perseverance when beliefs persist after the evidence for them is shown to be false ; 3 the irrational primacy effect a greater reliance on information encountered early in a series ; and 4 illusory correlation when people falsely perceive an association between two events or situations. A series of psychological experiments in the s suggested that people are biased toward confirming their existing beliefs.

In the area of patient safety, recent attention has focused on diagnostic error. The reduction of diagnostic error is an important goal because of its associated morbidity and potential preventability. A critical subset of diagnostic errors arises through cognitive errors, especially those associated with failures in perception, failed heuristics, and biases; collectively, these have been referred to as cognitive dispositions to respond CDRs. Historically, models of decision-making have given insufficient attention to the contribution of such biases, and there has been a prevailing pessimism against improving cognitive performance through debiasing techniques. Recent work has catalogued the major cognitive biases in medicine; the author lists these and describes a number of strategies for reducing them "cognitive debiasing". Principle among them is metacognition, a reflective approach to problem solving that involves stepping back from the immediate problem to examine and reflect on the thinking process. Further research effort should be directed at a full and complete description and analysis of CDRs in the context of medicine and the development of techniques for avoiding their associated adverse outcomes.


The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. Aug;78(8) doi: /


Diagnostic error, overconfidence and self-knowledge

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Mathieu Nendaz a,b , Arnaud Perrier a. The majority of cognitive errors are not related to knowledge deficiency but to flaws in data collection, data integration, and data verification that may lead to premature diagnostic closure. This paper reviews some aspects of the literature on cognitive psychology that help us to understand reasoning processes and knowledge organisation and summarises biases related to clinical reasoning.

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Им станут известны имена и местонахождение всех лиц, проходящих по федеральной программе защиты свидетелей, коды запуска межконтинентальных ракет. Мы должны немедленно вырубить электроснабжение. Немедленно. Казалось, на директора его слова не произвели впечатления. - Должен быть другой выход. - Да, - в сердцах бросил Джабба.

Выпей воды. Ты очень бледна.  - Затем повернулся и вышел из комнаты. Сьюзан взяла себя в руки и быстро подошла к монитору Хейла. Протянула руку и нажала на кнопку.

 Танкадо успел отдать его за мгновение до смерти. Все были в растерянности. - Ключ… - Ее передернуло.  - Коммандер Стратмор отправил кого-то в Испанию с заданием найти ключ. - И что? - воскликнул Джабба.

Подумала, что, может быть, спутала последовательность нажатия клавиш. Немыслимо, - подумала .

4 Response
  1. Hartwolfducti1960

    Diagnostic errors, constituted by a missed, wrong, or delayed diagnosis detected later by additional tests or findings, are one of the most vexing issues in medicine.

  2. Kevin H.

    The reduction of diagnostic error is an important goal because of its associated morbidity and potential preventability. Considerable potential exists for reducing cognitive diagnostic errors with this approach. The author provides an extensive list of CDRs and a list of strategies to reduce diagnostic errors.

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