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Diagnostic error and clinical reasoning.

Geoffrey R Norman1, Kevin W Eva

  • 1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Norman@mcmaster.ca

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Diagnostic errors stem from multiple thinking styles, not just cognitive biases. Interventions encouraging both analytical and non-analytical reasoning show modest improvements in diagnostic accuracy.

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Area of Science:

  • Medical Education
  • Cognitive Psychology
  • Clinical Reasoning

Background:

  • Diagnostic errors are a significant concern in healthcare.
  • Existing literature often attributes these errors to cognitive biases and non-analytical (System 1) thinking.

Purpose of the Study:

  • To critically review the literature on diagnostic errors and their cognitive underpinnings.
  • To explore the role of dual-process models of thinking in clinical reasoning and error causation.
  • To evaluate strategies for mitigating diagnostic errors.

Main Methods:

  • Literature review integrating research on diagnostic errors, clinical reasoning, and psychological dual-process models.
  • Synthesis of evidence to identify causes of error and potential solutions.

Main Results:

  • Little evidence supports the claim that diagnostic errors are solely due to non-analytical (System 1) reasoning.
  • Experts are prone to errors even when employing systematic, analytical (System 2) thinking.
  • Educational strategies focusing on cognitive biases have limited effectiveness.
  • Interventions promoting both analytical and non-analytical reasoning yield small but consistent accuracy improvements.

Conclusions:

  • Diagnostic errors arise from complex interactions, not just cognitive biases or a single thinking mode.
  • Both analytical and non-analytical reasoning processes are implicated in diagnostic errors.
  • Targeted strategies fostering diverse reasoning approaches may offer incremental gains in diagnostic accuracy.