Cognitive Errors

26 Jan

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
[youtube=http://www.youtube.com/watch?v=-2O_GeRSOFo&w=640&h=360]

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.

One Reply to “Cognitive Errors”

  1. 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.

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