Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug.;78(8):775–780. PMID 12915363
[Via R&R in the fast lane of course]
This is a hugely important topic, and one that I love thinking about.
The author lists 2 pages worth of common cognitive errors.
It’s a little bit like this ad
Except it’s less “how do you eat yours” and more, “how do you screw up and kill yours…”
The same author also has a whole bunch of talks up on freeemergencytalks.net (Joe Lex’s awesome repository) and they’re well worth checking out.
My confession, my vice and sin is “premature closure.” From the paper.
a powerful CDR (cognitive disposition to respond) accounting for a high proportion of missed diagnoses. It is the tendency to apply premature closure to the decision- making process, accepting a diagnosis before it has been fully verified. The consequences of the bias are reflected in the maxim: ‘‘When the diagnosis is made, the thinking stops.’’
I have made all kinds of mistakes due to this bad boy. I’m still working on the perfect ploy to stop myself making the same mistake.
Anyhow the paper is a must read.
Interestingly the term “cognitive dispositions to respond” kept making me think of the way that Aristotle used the term “virtue”. To be fair Aristotle meant it as a disposition to do the right thing and Croskerry uses it as a disposition to do the wrong thing. Aristotle may been a bit of crazy man on some things (he wasn’t entirely sure women were true people…) he did have some wonderful insight into how humans relate.
I think my worst habit is “search satisfying”. Made all the easier if the clock is ticking and you need a quick diagnosis to facilitate patient disposition. Even worse if the first diagnosis that you uncover explains (most of) their symptoms.
Search satisfying: reflects the universal tendency to call off a search once something is found. Comorbidities, second foreign bodies, other fractures, and coingestants in poisoning may all be missed.