COGNITIVE ERRORS IN MEDICINE PART 1

Course overview

Since the 1999 release of the Institute of Medicine report entitled ¿To Err is Human,¿ the patient safety movement has gained massive momentum. A patient safety program typically has several facets, but one of the key components is the investigation of serious adverse medical events. Most methods of error analysis focus on problems inherent in the ¿system¿ rather than individual behavior. Recently, however, new concepts regarding the origin of medical errors have been introduced in the medical literature. These concepts deal with the psychology of clinical decision-making. Practitioners are subject to heuristics and biases, or cognitive dispositions to respond, which influence clinical decision-making and can result in cognitive errors. Thus, the technique of cognitive error analysis, used alone or in combination with other methods of error analysis, can serve as a valuable resource when added to the patient safety toolbox of any individual or organization. In this activity, we examine how thought processes influence decision-making, affect patient care, and contribute to medical mistakes. We introduce six types of cognitive errors and discuss real case examples to illustrate how cognitive errors contributed to delayed or missed diagnoses. After completing this activity, practitioners should be able to: employ strategies to minimize the occurrence of cognitive errors in clinical practice; determine when a patient encounter may involve the bias of search satisficing in order to improve clinical decision-making and reduce the incidence of diagnostic errors; and determine when a patient encounter may involve the bias of representativeness restraint in order to improve clinical decision-making and reduce the incidence of diagnostic errors.