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Related Experiment Videos

Cognitive errors in diagnosis: instantiation, classification, and consequences.

J P Kassirer1, R I Kopelman

  • 1Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.

The American Journal of Medicine
|April 1, 1989
PubMed
Summary

Cognitive errors in clinical reasoning lead to diagnostic errors. Identifying and classifying these thinking faults is crucial for understanding and preventing patient harm.

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Area of Science:

  • Cognitive Science
  • Medical Education
  • Diagnostic Error Research

Background:

  • Diagnostic errors are a significant patient safety concern.
  • Faulty clinical cognition is a known contributor to diagnostic errors.
  • A systematic classification of cognitive errors in diagnosis is lacking.

Purpose of the Study:

  • To identify and classify cognitive errors in the diagnostic process.
  • To analyze diagnostic errors stemming from flawed clinical cognition.
  • To provide a framework for understanding the origins of diagnostic mistakes.

Main Methods:

  • Analysis of 40 transcripts from a clinical reasoning problem-solving series.
  • Application of a cognitive science framework to identify errors.

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  • Detailed examples and consequences of identified cognitive faults were documented.

    • Main Results:

    • Multiple cognitive errors were identified across all diagnostic process steps.
    • A provisional classification of cognitive errors was developed.
    • Errors occurred in triggering, context formulation, information processing, and verification.

    Conclusions:

    • Cognitive errors in clinical reasoning are identifiable and classifiable.
    • These cognitive faults can lead to significant patient morbidity.
    • Classification of cognitive errors is a foundational step for future research on diagnostic error prevention.