Palavras-chave
diagnóstico
erros diagnósticos
vieses
Como Citar
Resumo
O processo diagnóstico em saúde é complexo, contexto-dependente, interativo e não linear e pode envolver pacientes, familiares, clínicos individuais e equipes de saúde. A redução do erro diagnóstico é uma meta importante nas profissões de saúde devido à morbidade associada e possível prevenção. O erro diagnóstico é geralmente de origem multifatorial, envolvendo tanto fatores relacionados ao sistema quanto componentes cognitivos. Os mecanismos de resolução de erros cognitivos têm sido menos estudados do que aqueles relacionados ao sistema. A literatura científica sugere que o raciocínio Tipo 1 (intuitivo) e Tipo 2 (analítico) contribuem para erros diagnósticos. Alguns tipos de erros são analisados de acordo com a visão de diferentes autores e os processos de raciocínio que podem levar ao erro.
Referências
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
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2025 Maria del Carmen Lopez Jordi, Alicia Gómez