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The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them

Croskerry, Pat MD, PhD

Articles

In the area of patient safety, recent attention has focused on diagnostic error. The reduction of diagnostic error is an important goal because of its associated morbidity and potential preventability. A critical subset of diagnostic errors arises through cognitive errors, especially those associated with failures in perception, failed heuristics, and biases; collectively, these have been referred to as cognitive dispositions to respond (CDRs). Historically, models of decision-making have given insufficient attention to the contribution of such biases, and there has been a prevailing pessimism against improving cognitive performance through debiasing techniques. Recent work has catalogued the major cognitive biases in medicine; the author lists these and describes a number of strategies for reducing them (“cognitive debiasing”). Principle among them is metacognition, a reflective approach to problem solving that involves stepping back from the immediate problem to examine and reflect on the thinking process. Further research effort should be directed at a full and complete description and analysis of CDRs in the context of medicine and the development of techniques for avoiding their associated adverse outcomes. Considerable potential exists for reducing cognitive diagnostic errors with this approach. The author provides an extensive list of CDRs and a list of strategies to reduce diagnostic errors.

Dr. Croskerry is associate professor, Departments of Emergency Medicine and Medical Education, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada. He is also a member of the Center for Safety in Emergency Care, a research consortium of the University of Florida College of Medicine, Dalhousie University Faculty of Medicine, Northwestern University The Feinberg School of Medicine, and Brown Medical School.

Correspondence and requests for reprints should be sent to Dr. Croskerry, Emergency Department, Dartmouth General Hospital Site, Capital District, 325 Pleasant Street, Dartmouth, Nova Scotia, Canada B2Y 4G8; telephone: (902) 465-8491; fax: (902) 460-4148; e-mail: 〈xkerry@accesscable.net〉.

The author gratefully acknowledges support through a Senior Clinical Research Fellowship from the Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, and a grant (#P20HS11592-02) awarded by the Agency for Healthcare Research and Quality.

Two responses to this article are printed after it.

© 2003 Association of American Medical Colleges