Keywords
diagnosis
diagnostic errors
biases
How to Cite
Abstract
The diagnostic process in healthcare is complex, context-dependent, interactive, and non-linear and can involve patients, families, individual clinicians, and health teams. Reducing diagnostic errors is an important goal in the health professions due to its associated morbidity and possible prevention. Diagnostic error is usually multifactorial in origin, involving both system-related factors and cognitive components. The mechanisms for solving cognitive errors have been less studied than those related to the system. The scientific literature suggests that Type 1 (intuitive) and Type 2 (analytical) reasoning contribute to diagnostic errors. Some types of errors are analyzed according to the vision of different authors and the processes in reasoning that can lead to error.
References
Barrows HS, Tamblyn RM. Problem-based learning. An approach to medical education. New York. Springer 1980.
Charlin B, Tardif J, Boshuizen HP. Scripts, and medical diagnostic knowledge: theory and applications for clinical reasoning instruction and research. Acad Med 2000.
López Jordi MC, Gómez A. El razonamiento clínico con enfoque didáctico. InterCambios [online]. 2020, Vol.7, No. 2: pp.16-25. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S2301-
Loayssa Lara y C. Fuentes Goñi. Razonamiento analítico y no analítico en el diagnóstico clínico. Sociedad Española de Medicina de Familia y Comunitaria. 2015. Navarra. Disponible en: https://www.doctutor.es/2011/03/02/ideas-y-reflexiones-en-educacion-medica-marzo-2011/
Eva K. W. What every teacher needs to know about clinical reasoning. Med Educ, 2005;39(1): 98-106. Available in: https://api.semanticscholar.org/CorpusID:7674831
National Academies of Sciences, Engineering, and Medicine. Improving diagnosis in health care. Washington, DC: The National Academies Press.2015. https://doi.org/10.17226/21794
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80. doi: 10.1097/00001888-200308000-00003. PMID: 12915363. Disponible en: https://pubmed.ncbi.nlm.nih.gov/12915363/
Croskerry P. Bias: a normal operating characteristic of the diagnosing brain. Diagnosis 1: 2014, 23–27. Available in: https://www.researchgate.net/publication/337405644_Becoming_Less_Wrong_and_More_Rational_in_Clinical_Decisionmaking
Mamede S. Schmidt H. The structure of reflective practice in medicine. Med Educ 2004;38: 1302-08.
Mamede S, Van Gog T, Van den Berge K, et al. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA 2010.;304(11):1198-1203. doi:10.1001/jama.2010.1276. Available in: https://jamanetwork.com/journals/jama/fullarticle/186585
Allen SW, Brooks LR, Rosenthal D. Effect of prior examples on rule-based diagnostic performance. Res Med Educ.1988; 27:9–14.
Brooks LR, Norman GR, Allen SW. Role of specific similarity in a medical diagnostic task. J Exp Psychol Gen 1991;120:278–287.
Graber ML, Franklin N, Gordon R. Diagnostic Error in Internal Medicine. Arch Intern Med. 2005;165:1493-99, Available in: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486642
Graber ML, Kissam S, Payne VL, et al. Cognitive interventions to reduce diagnostic error: A narrative review. BMJ Qual Saf. 2012;21:535–557. Available in: https://www.researchgate.net/publication/373265024_Errors_in_clinical_diagnosis_a_narrative_review
Norman GR, Monteiro SD, Sherbino J, Ilgen JS, Schmidt HG, Mamede S. The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking. Acad Med. Jan 2017;92(1):23-30. doi: 10.1097/ACM.0000000000001421. PMID: 27782919. Available in: https://med.virginia.edu/faculty-affairs/wp-content/uploads/sites/458/2016/04/Journal-Club-Geoff-Norman.pdf
Croskerry P. Becoming Less Wrong (and More Rational) in Clinical Decision making. Ann Emerg Med 2020; 75:218-220.
Croskerry P, Campbell SG. A Cognitive Autopsy Approach Towards Explaining Diagnostic Failure. Cureus 2021;9;13(8):e17041. doi: 10.7759/cureus.17041. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8426159/
Croskerry P, Campbell SG, Petrie DA. The challenge of cognitive science for medical diagnosis. Cogn Res Princ Implic. 2023 Feb 9;8(1):13. doi: 10.1186/s41235-022-00460-z. PMID: 36759370; PMCID: PMC9911579.
Nolan TW. (2000). System changes to improve patient safety. British Medical Journal 2000; 320:771-773. Available in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117771/
Vally Z.I, Khammissa R, Feller G, Ballyram R, Beetge M, Feller L. Errors in clinical diagnosis: a narrative review. Journal of International Medical Research.2023; Vol. 51(8) 1–10. DOI: 10.1177/03000605231162798, Available in: https://journals.sagepub.com/doi/full/10.1177/03000605231162798
Staal, J, Alsma, J, Mamede S. et al. The relationship between time to diagnose and diagnostic accuracy among internal medicine residents: a randomized experiment. BMC Med Educ 21, 227 (2021). https://doi.org/10.1186/s12909-021-02671-2
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