Cognitive bias and medical errors

Elston, Dirk M.

doi:10.1016/j.jaad.2019.06.1284

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…It often is difficult for staff members to filter the numerous distractions present in the surgical environment. Sometimes staff members may exhibit cognitive bias , in which they mistakenly filter important signals that they believe are unimportant . When perioperative nurses perform routine interventions (eg, counting, labeling specimens), the process can become repetitive and nurses may “see what they expect to see” rather than what actually is present.…”

Section: Causes Of Lost Surgical Specimensmentioning

confidence: 99%

“…Sometimes staff members may exhibit cognitive bias, in which they mistakenly filter important signals that they believe are unimportant. 6 When perioperative nurses perform routine interventions (eg, counting, labeling specimens), the process can become repetitive and nurses may "see what they expect to see" rather than what actually is present. One study showed that cognitive bias was a factor in 36% of studied diagnostic medical errors.…”

Section: Prevalence Of Errorsmentioning

confidence: 99%

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A Multidisciplinary Approach for Reducing Lost Surgical Specimens

Morris¹

2020

AORN Journal

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Section: Causes Of Lost Surgical Specimensmentioning

confidence: 99%

Section: Prevalence Of Errorsmentioning

confidence: 99%

A Multidisciplinary Approach for Reducing Lost Surgical Specimens

Morris¹

2020

AORN Journal

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“…The causes of diagnostic errors have been studied from various perspectives and with various explanatory frameworks, including the dual-process model (9), studies of cognitive biases (10)(11)(12)(13)(14)(15), and the analysis of system errors (3,4,16). Previous studies have hypothesized that cognitive biases contribute more significantly to errors than physician memory and experience (11,(17)(18)(19)(20)(21)(22)(23). However, determining the cause of internists' diagnostic errors remains challenging for several reasons (4,6,(24)(25)(26).…”

Section: Introductionmentioning

confidence: 99%

Japanese Internists' Most Memorable Diagnostic Error Cases: A Self-reflection Survey

et al. 2024

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Objective The etiologies of diagnostic errors among internal medicine physicians are unclear. To understand the causes and characteristics of diagnostic errors through reflection by those involved in them. Methods We conducted a cross-sectional study using a web-based questionnaire in Japan in January 2019. Over a 10-day period, a total of 2,220 participants agreed to participate in the study, of whom 687 internists were included in the final analysis. Participants were asked about their most memorable diagnostic error cases, in which the time course, situational factors, and psychosocial context could be most vividly recalled and where the participant provided care. We categorized diagnostic errors and identified contributing factors (i.e., situational factors, data collection/interpretation factors, and cognitive biases). Results Two-thirds of the identified diagnostic errors occurred in the clinic or emergency department. Errors were most frequently categorized as wrong diagnoses, followed by delayed and missed diagnoses. Errors most often involved diagnoses related to malignancy, circulatory system disorders, or infectious diseases. Situational factors were the most cited error cause, followed by data collection factors and cognitive bias. Common situational factors included limited consultation during office hours and weekends and barriers that prevented consultation with a supervisor or another department. Conclusion Internists reported situational factors as a significant cause of diagnostic errors. Other factors, such as cognitive biases, were also evident, although the difference in clinical settings may have influenced the proportions of the etiologies of the errors that were observed. Furthermore, wrong, delayed, and missed diagnoses may have distinctive associated cognitive biases.

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“…clinical reasoning or mental sources of diagnostic errors and cognitive bias. 8 In this regard, the author has used a symbol to visualize the two polarized approaches (Figure 1) and to explain the importance of the dual process model. In addition, students have received assignments to distinguish key differences between intuitive and analytic clinical reasoning (examples listed in Table 1).…”

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confidence: 99%

Metacognition in teaching dermatology—Role of the dual process model

Salava

2023

Acad Dermatol Venereol

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Dear Editor, In dermatology, a correct visual diagnosis is essential for successful patient care. Therefore, the key component of its teachings must be repetitive visual learning such as different cases that enable students to create mental templates. While experience develops, these are subsequently compared in every new patient. 1 The actual process of reasoning (metacognition), or in other words the mental pathways that lead to the diagnosis, remain largely obscure and are frequently overlooked in medical education. 2 Many theories have been proposed about how experienced clinicians reason and diagnose. One of these, the dual process theory, comes probably very near to the clinical reality in dermatology because of its important role of visual findings. 3,4 The model polarizes two different modes of recognition and thinking, a fast, intuitive method (system 1) and a slower, analytic method (system 2). The first one is characterized by prima vista diagnosis, pattern recognition and mental shortcuts (heuristics), but limited by tendency to bias. The other, a more analytical approach, builds on careful analysis of complex cases, algorithms and active deduction. However, putting the clinician under a higher cognitive load and consuming time. 5 Experienced clinicians are most likely to use an interplay of intuitive and analytic thinking depending on the clinical context and the individual findings, described as the cognitive continuum theory. 6 Although this might sound very theoretical, every practicing dermatologist recognizes the dichotomy of easier, "doorstep diagnoses" compared to complex multi-faceted patients with confounding signs and symptoms that require careful analysis.Students of dermatology often do not yet possess ample clinical experience and the needed number of visual repetitions that are prerequisites for intuitive recognition. They therefore rely highly on analytic thinking. 7 This is one of the reasons, why algorithms, lists of differentials, and in general, a mental framework is so desired in the beginning of medical studies.The author has been teaching clinical dermatology and observational skills for many years at the University of Helsinki, Finland, as parts of undergraduate courses or postgraduate specialist education. During teachings, the author has observed, that students are often unaware of metacognitive processes, such as the above-described modes of

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Cognitive bias and medical errors

Cited by 3 publications

References 8 publications

A Multidisciplinary Approach for Reducing Lost Surgical Specimens

A Multidisciplinary Approach for Reducing Lost Surgical Specimens

Japanese Internists' Most Memorable Diagnostic Error Cases: A Self-reflection Survey

Metacognition in teaching dermatology—Role of the dual process model

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