Misdiagnosis and failure to diagnose in emergency care: Causes and empathy as a solution

Pelaccia, Thierry; Messman, Anne; Kline, Jeffrey A.

doi:10.1016/j.pec.2020.02.039

Cited by 23 publications

(17 citation statements)

References 51 publications

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“…6 System 1 is especially useful in fast-paced, clinical settings like the ED, where it can ease cognitive load and facilitate efficient throughput while reserving working memory. 7,8 A qualitative study of emergency physicians (EP) supported this observation, by demonstrating that most of their diagnostic hypotheses were generated without conscious effort and either prior to or within the first five minutes of an initial patient evaluation. 9 By contrast, system 2 is deliberative, measured, and analytical.…”

Section: Understanding How We Thinkmentioning

confidence: 96%

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Review of the Basics of Cognitive Error in Emergency Medicine: Still No Easy Answers

Hartigan

Brooks

Hartley

et al. 2020

WestJEM

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Section: Understanding How We Thinkmentioning

confidence: 96%

“…Comparison of the dual-process theory of thought: system 1 (intuition) and system 2 (analytic)5,7,8 Western Journal of Emergency MedicineHartigan et al The Basics of Cognitive Error in EM and Updates: Still No Easy Answers…”

mentioning

confidence: 99%

Review of the Basics of Cognitive Error in Emergency Medicine: Still No Easy Answers

Hartigan

Brooks

Hartley

et al. 2020

WestJEM

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show abstract

“…Perhaps more critically, how might this perception impact their sense of responsibility? Pertaining to these questions, there is a highly focused literature on how diagnostic errors promote a rhetoric of individual clinician vigilance, through de‐biasing, cautiousness, and personal reflection 15‐22 . On one hand, theories on how cognitive biases impact diagnostic error offer a sensitive approach: physicians make errors because of cognitive limitations and innate tendencies.…”

Section: Introductionmentioning

confidence: 99%

“I made a mistake!”: A narrative analysis of experienced physicians' stories of preventable error

Kandasamy

Vanstone

Colvin

et al. 2021

Evaluation Clinical Practice

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Rationale, aims, and objectives The complexity of healthcare systems makes errors unavoidable. To strengthen the dialogue around how physicians experience and share medical errors, the objective of this study was to understand how generalist physicians make meaning of and grow from their medical errors. Methods This study used a narrative inquiry approach to conduct and analyse in‐depth interviews from 26 physicians from the generalist specialties of emergency, internal, and family medicine. We gathered stories via individual interview, analysed them for key components, and rewrote a “meta‐story” in a chronological sequence. We conceptualized the findings into a metaphor to draw similarities, learn from, and apply new principles from other fields of practice. Results Through analysis we interpreted the story of a physician who is required to make numerous decisions in a short period of time in different clinical environments among the patient's family and whilst abiding by existing rules and regulations. Through sharing stories of success and failure, the clinical supervisor can help optimize the physician's emotional growth and professional development. Similarly, through sharing and learning from stories, colleagues and trainees can also contribute to the growth of the protagonist's character and the development of clinic, hospital, and healthcare system. Conclusion We draw parallels between the clinical setting and a generalist physician's experiences of a medical error with the environment and practices within professional sports. Using this comparison, we discuss the potential for meaningful coaching in medical education.

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“…Perhaps more critically, how might this perception impact their sense of responsibility? Pertaining to these questions, there is a highly focused literature on how diagnostic errors promote a rhetoric of individual clinician vigilance, through de-biasing, cautiousness, and personal reflection [15][16][17][18][19][20][21][22] . On one hand, theories on how cognitive biases impact diagnostic error offer a sensitive approach: physicians make errors because of cognitive limitations and innate tendencies.…”

Section: Introductionmentioning

confidence: 99%

“I made a mistake!”: a narrative analysis of experienced physicians’ stories of preventable error

Kandasamy

Vanstone

Colvin

et al. 2020

Preprint

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Rationale, aims, and objectives: The complexity of healthcare systems makes errors unavoidable. To strengthen the dialogue around how physicians experience and share medical errors, the objective of this study was to understand how experienced generalist physicians make meaning of and grow from their medical errors. Methods: This study used a narrative inquiry approach to conduct and analyze in-depth interviews from 26 physicians from the generalist specialties of emergency, internal, and family medicine. We gathered stories via individual interview, analyzed them for key components, and rewrote a 'metastory' in a chronological sequence. We conceptualized the findings into a metaphor to draw similarities, learn from, and apply new principles from other fields of practice. Results: Through analysis we interpreted the story of an elite athlete (physician) who is required to make numerous decisions in a short period of time within the construct of a chaotic sports field (clinical environment) among spectators (the patient's family) whilst abiding by existing rules and regulations. Through sharing stories of success and failure, the team coach (clinical mentor) helps optimize the players' professional and psychological development. Similarly, through sharing and learning from stories, team members (colleagues) and junior team members (trainees) also contribute to the growth of the protagonist's character and the development of the overall team (clinic/hospital) and sport (healthcare system). Conclusion: We draw parallels between the clinical setting and a generalist physician's experiences of a medical error with the environment and practices within professional sports. Using this comparison, we discuss the potential for meaningful coaching in medical education.

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Misdiagnosis and failure to diagnose in emergency care: Causes and empathy as a solution

Cited by 23 publications

References 51 publications

Review of the Basics of Cognitive Error in Emergency Medicine: Still No Easy Answers

Review of the Basics of Cognitive Error in Emergency Medicine: Still No Easy Answers

“I made a mistake!”: A narrative analysis of experienced physicians' stories of preventable error

“I made a mistake!”: a narrative analysis of experienced physicians’ stories of preventable error

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