<i>Annals</i> Clinical Decision Making: Avoiding Cognitive Errors in Clinical Decision Making
Daniel Restrepo, Katrina Armstrong, Joshua P. Metlay
Abstract
Special Articles2 June 2020Annals Clinical Decision Making: Avoiding Cognitive Errors in Clinical Decision MakingDaniel Restrepo, MD, Katrina A. Armstrong, MD, MS, and Joshua P. Metlay, MD, PhDDaniel Restrepo, MDMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.R., K.A.A., J.P.M.), Katrina A. Armstrong, MD, MSMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.R., K.A.A., J.P.M.), and Joshua P. Metlay, MD, PhDMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.R., K.A.A., J.P.M.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-3692 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Making a diagnosis is perhaps the most frequently performed and important procedure in an internist's wheelhouse. Indeed, a patient's therapeutic options and prognosis often center around the right diagnosis being made in a timely fashion. Unfortunately, diagnostic errors are common, with frequency estimates ranging from 10% to 40% in some studies (1, 2). Furthermore, misdiagnosis is more likely to be considered negligent and have proportionately higher morbidity and morbidity than other errors (3, 4).Cognitive psychology research over the past 40 years has led to the development of dual process theory, wherein 2 central cognitive systems, system 1 and system ...References1. Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2008;121:S2-23. [PMID: 18440350] doi:10.1016/j.amjmed.2008.01.001 CrossrefMedlineGoogle Scholar2. Shojania KG, Burton EC, McDonald KM, et al. Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA. 2003;289:2849-56. [PMID: 12783916] CrossrefMedlineGoogle Scholar3. Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377-84. [PMID: 1824793] CrossrefMedlineGoogle Scholar4. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370-6. [PMID: 1987460] CrossrefMedlineGoogle Scholar5. Evans J. Heuristic and analytic processes in reasoning. Br J Psychol. 1984;75:451-68. doi:10.1111/j.2044-8295.1984.tb01915.x CrossrefGoogle Scholar6. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78:775-80. [PMID: 12915363] CrossrefMedlineGoogle Scholar7. Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005;165:1493-9. [PMID: 16009864] CrossrefMedlineGoogle Scholar8. Norman GR, Monteiro SD, Sherbino J, et al. The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Acad Med. 2017;92:23-30. [PMID: 27782919] doi:10.1097/ACM.0000000000001421 CrossrefMedlineGoogle Scholar9. Everhart JE. Gallstones. In: Everhart JE, eds. Digestive Diseases in the United States: Epidemiology and Impact. NIH publication no. 94-1447. Washington, D.C.: U.S. Government Printing Office; 1994:647-69. Google Scholar10. Werner M, Prytz H, Ohlsson B, et al. Epidemiology and the initial presentation of autoimmune hepatitis in Sweden: a nationwide study. Scand J Gastroenterol. 2008;43:1232-40. [PMID: 18609163] doi:10.1080/00365520802130183 CrossrefMedlineGoogle Scholar11. Armstrong KA, Metlay JP. Annals clinical decision making: using a diagnostic test. Ann Intern Med. 2020;172:604-9. doi:10.7326/M19-1940 LinkGoogle Scholar12. 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;304:1198-203. [PMID: 20841533] doi:10.1001/jama.2010.1276 CrossrefMedlineGoogle Scholar13. Graber ML, Kissam S, Payne VL, et al. Cognitive interventions to reduce diagnostic error: a narrative review. BMJ Qual Saf. 2012;21:535-57. [PMID: 22543420] doi:10.1136/bmjqs-2011-000149 CrossrefMedlineGoogle Scholar14. Ely JW, Graber ML, Croskerry P. Checklists to reduce diagnostic errors. Acad Med. 2011;86:307-13. [PMID: 21248608] doi:10.1097/ACM.0b013e31820824cd CrossrefMedlineGoogle Scholar15. National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care. Washington, DC: National Academies Pr; 2015. Google Scholar16. Green MJ, Croskerry P, Rieck R. Annals Graphic Medicine - Bed blocker. Ann Intern Med. 2020;172:W142-W148. doi:10.7326/G20-0001 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.R., K.A.A., J.P.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3692.Corresponding Author: Daniel Restrepo, MD, Core Educator Faculty and Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 550, Boston, MA 02114; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Restrepo: Core Educator Faculty and Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 550, Boston, MA 02114.Dr. Armstrong: Massachusetts General Hospital, Gray-Bigelow 7, 55 Fruit Street, Boston, MA 02114.Dr. Metlay: Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114.Author Contributions: Conception and design: D. Restrepo, K.A. Armstrong, J.P. Metlay.Analysis and interpretation of the data: J.P. Metlay.Drafting of the article: D. Restrepo, K.A. Armstrong, J.P. Metlay.Critical revision of the article for important intellectual content: K.A. Armstrong, J.P. Metlay.Final approval of the article: D. Restrepo, K.A. Armstrong, J.P. Metlay.Administrative, technical, or logistic support: K.A. Armstrong.This article was published at Annals.org on 21 April 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Decision Making: Nurturing Our Core Skills Darren B. Taichman , Sankey V. Williams , and Christine Laine Clinical Decision Making: Nurturing Our Core Skills Darren B. Taichman , Sankey V. Williams , and Christine Laine Annals Clinical Decision Making: Communicating Risk and Engaging Patients in Shared Decision Making Katrina A. Armstrong and Joshua P. Metlay Annals Graphic Medicine - Bed Blocker Michael J. Green , Pat Croskerry , and Ray Rieck Annals Graphic Medicine - Bed Blocker Michael J. 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Olson, MDAnnals Clinical Decision Making: Communicating Risk and Engaging Patients in Shared Decision MakingKatrina A. Armstrong, MD, MS and Joshua P. Metlay, MD, PhDAnnals Clinical Decision Making: Using a Diagnostic TestKatrina A. Armstrong, MD, MS and Joshua P. Metlay, MD, PhDAnnals Clinical Decision Making: Weighing Evidence to Inform Clinical DecisionsJoshua P. Metlay, MD, PhD and Katrina A. Armstrong, MD, MSClinical Decision Making: Nurturing Our Core SkillsDarren B. Taichman, MD, PhD, Executive Editor, Sankey V. Williams, MD, Deputy Editor, and Christine Laine, MD, MPH, Editor in Chief 2 June 2020Volume 172, Issue 11Page: 747-751KeywordsChronic obstructive pulmonary diseaseDecision makingDyspneaHeart failureHospital medicineLiverPatientsPulmonary functionReasoningThorax ePublished: 21 April 2020 Issue Published: 2 June 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...