No simple fix for fixation errors: cognitive processes and their clinical applications

Abstract

SummaryFixation errors occur when the practitioner concentrates solely upon a single aspect of a case to the detriment of other more relevant aspects. These are well recognised in anaesthetic practice and can contribute significantly to morbidity and mortality. Improvement in patient safety may be assisted by development and application of countermeasures to fixation errors. Cognitive psychologists use ‘insight problems’ in a laboratory setting, both to induce fixation and to explore strategies to escape from fixation. We present some results from a series of experiments on one such insight problem and consider applications that may have relevance to anaesthetic practice.

Cognitive Bias in Clinical Medicine

“…There remains scepticism as to the role of debiasing from some commentators despite some of the promising results described. 55,80,81 They argue the hardwired nature of some of these cognitive biases is unavoidable and to suggest they can be easily fi xed seems unlikely. Certainly there are enough negative studies to merit such concerns.…”

Cognitive aids: time for a change?

“…In other words, there is always potential for disaster in emergency management because of an unwillingness or inability to revert to more systematic thinking. This is termed fixation error [13] and it has been well described in anaesthesia [14,15]. An example of this type of error in the literature is that of a case of ventilation failure during anaesthetic management of a paediatric patient.…”

What is simulation for?

“…Importantly, this process is not easily made conscious and the doctor may not be aware of many -or indeed any -of the key attributes of the patient that led to the initial diagnosis. This is evident in the problem of fixation, where prior influences can lead individuals to focus on one solution (activate one schema) and then go on to ignore what seem in retrospect to be obvious solutions [19]. Rather than being the primary mode of decision making, conscious thought can therefore be seen as a supervisory and fine Anaesthesia 2012, 67, 213-225 Editorial tuning process.…”