Rational error in internal medicine

IM - Original

Abstract

Epistemologists have selected two basic categories: that of errors committed in scientific research, when a researcher devises or accepts an unfounded hypothesis, and that of mistakes committed in the application of scientific knowledge whereby doctors rely on knowledge held to be true at the time in order to understand an individual patient’s signs and symptoms. The paper will deal exclusively with the latter, that is to say the mistakes which physicians make while carrying out their day-to-day medical duties. The paper will deal with the mistakes committed in medicine trying also to offer a classification. It will take into account also examples of mistakes in Bayesian reasoning and mistakes of reasoning committed by clinicians regard inductive reasoning. Moreover, many other mistakes are due to fallacies of deductive logic, logic which they use on a day-to-day basis while examining patients in order to envisage the consequences of the various diagnostic or physiopathologic hypotheses. The existence of a different type of mistakes that are part of the psychology of thought will be also pointed out. We conclude that internists often make mistakes because, unknowingly, they fail to reason correctly. These mistakes can occur in two ways: either because he does not observe the laws of formal logic, or because his practical rationality does not match theoretical rationality and so his reasoning becomes influenced by the circumstances in which he finds himself.

Keywords

Mistake Bayesian reasoning Inductive reasoning Deductive logic Psychology of thought 

References

  1. 1.
    Debenedetti E (1947) Le vie dell’errore clinico. Minerva Medica, TorinoGoogle Scholar
  2. 2.
    Poli E (1965) Metodologia medica. Principi di Logica e pratica clinica. Rizzoli, MilanoGoogle Scholar
  3. 3.
    Austoni M, Federspil G (1975) Principi di metodologia clinica. Cedam, PadovaGoogle Scholar
  4. 4.
    Hillsdale N (1994) Human error in medicine. In: Bogner MJ (ed) Erlbaum Associates, New JerseyGoogle Scholar
  5. 5.
    Kohn L, Corrigan J, Donaldsom M (2001) To err is human. Building a safer health system. National Academy Press, Washington, DC, pp 509–513Google Scholar
  6. 6.
    Brasel AJ, Layde PM, Hargarten S (2000) Evolution of error in medicine. Acad Emerg Med 7:1298–1302PubMedCrossRefGoogle Scholar
  7. 7.
    Kuhn GJ (2002) Diagnostic errors. Acad Emerg Med 9:740–750PubMedCrossRefGoogle Scholar
  8. 8.
    Bates DW, Gawande AA (2000) Error in medicine: what have we learned? Ann Intern Med 132:763–767PubMedGoogle Scholar
  9. 9.
    Hayward RA, Hofer T (2001) Estimating hospital death due to medical errors: preventability is in the eye of the reviewer. JAMA 286:415–420PubMedCrossRefGoogle Scholar
  10. 10.
    Marcon G, Ciuffrieda M, Corrò P (2001) Errori medici e danni causati dalle cure. Professione 2:34–40Google Scholar
  11. 11.
    Troxel DB (2006) Medicolegal aspects of error in pathology. Arch Pathol Lab Med 130:617–619PubMedGoogle Scholar
  12. 12.
    Antiseri D (1981) Teoria unificata del metodo. Liviana, PadovaGoogle Scholar
  13. 13.
    Baldini M (1994) Gli errori della medicina e gli sbagli del medico. G Clin Med Terapia 75:25–37Google Scholar
  14. 14.
    Federspil G, Vettor R, Pagano C (2001) Errore scientifico e sbaglio umano in medicina. Pathologica 93:595–605PubMedGoogle Scholar
  15. 15.
    Weingart S, Wilson RM, Gibberd R, Harrison B (2000) Epidemiology of medical error. BMJ 320:774–777PubMedCrossRefGoogle Scholar
  16. 16.
    Orlander J, Fincke B (2003) Morbidity and mortality conference. A Survey of academic Internal Medicine Departements. J Gen Intern Med 18:656–658PubMedCrossRefGoogle Scholar
  17. 17.
    Mazor KM, Fischer MA, Haley N, Hatem D, Quirm M (2005) Teaching and medical errors: primary care precipitors’ views. Med Educ 39:982–990PubMedCrossRefGoogle Scholar
  18. 18.
    Graber ML, Franklin N, Gordon R (2005) Diagnostic error in internal medicine. Arch Intern Med 165:1493–1499PubMedCrossRefGoogle Scholar
  19. 19.
    Charlin B, Gagnon R, Pelletier J, Foletti M, Abirizk G, Nasir C, Sauve E, Van Der Vleuten C (2006) Assessment of clinical reasoning in the context of uncertainty: the effect of variability within the reference panel. Med Educ 40:848–854PubMedCrossRefGoogle Scholar
  20. 20.
    Schwalbe J (1929) Errori diagnostici e terapeutici e criteri per evitarli. Vallardi, MilanoGoogle Scholar
  21. 21.
    Rugarli C (1989) L’errore in medicina clinica. Kos 51:16–30Google Scholar
  22. 22.
    Federspil G, Scandellari C (1993) L’errore clinico. Un’introduzione. In: Proceedings of the 94th Congr. Naz. Soc. It. Med. Int. Pozzi, Rome, pp 353–375Google Scholar
  23. 23.
    Federspil G, Vettor R (1998) Modi dell’errore clinico e responsabilità medica. Medic 6:219–224Google Scholar
  24. 24.
    Bufalini M (1876) Ricordi di Maurizio Bufalini sulla vita e sulle opere proprie. Le Monnier, FirenzeGoogle Scholar
  25. 25.
    Gasbarrini A (1951) Clinica medica generale. Istituto Editoriale Medico, BolognaGoogle Scholar
  26. 26.
    Burger M (1952) Errori diagnostici in medicina interna. Abruzzini Editore, RomaGoogle Scholar
  27. 27.
    Feinstein A (1967) Clinical Judgment. William & Wilkins, BaltimoreGoogle Scholar
  28. 28.
    Gordon R, Franklin N (2003) Cognitive Underpinnings of Diagnostic Error. Acad Med 78:782PubMedCrossRefGoogle Scholar
  29. 29.
    Croskerry P (2003) The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med 78:775–780PubMedCrossRefGoogle Scholar
  30. 30.
    Croskerry P (2003) Cognitive forcing strategies in clinical decision making. Ann Emerg Med 41:110–120PubMedCrossRefGoogle Scholar
  31. 31.
    Federspil G (2004) Logica clinica. I principi del metodo clinico. Mc Graw-Hill, MilanoGoogle Scholar
  32. 32.
    Scandellari C (2005) La diagnosi clinica. Principi metodologici dal procedimento decisionale. Masson, MilanoGoogle Scholar
  33. 33.
    Leape LL (1994) Error in medicine. JAMA 272:1851–1857PubMedCrossRefGoogle Scholar
  34. 34.
    Jevons WS (1948) Lezioni di logica elementare. Cedam, PadovaGoogle Scholar
  35. 35.
    Copi IM, Cohen C (1989) Introduction to logic. Macmillan, New YorkGoogle Scholar
  36. 36.
    Hacking I (2001) An introduction to probability and inductive logic. Press Univ Cambridge, CambridgeGoogle Scholar
  37. 37.
    Boniolo G, Vidali P (2002) Strumenti per ragionare. Bruno Mondadori, MilanoGoogle Scholar
  38. 38.
    Gilardoni A (2005) Logica e argomentazione. Mimesis, MilanoGoogle Scholar
  39. 39.
    Casadio C (2006) Logica e psicologia del pensiero. Carocci, RomaGoogle Scholar
  40. 40.
    Dovey SM, Meyers D, Phillips R, Green L, Fryer G, Galliner J, Kappus J, Grob P (2002) A preliminary taxonomy of medical errors in family practice. Qual Saf Health Care 11:233–238PubMedCrossRefGoogle Scholar
  41. 41.
    Bayes Th (1763) An essay towards solving a problem in the Doctrine of Chances. Phil Trans R Soc 53:370–418CrossRefGoogle Scholar
  42. 42.
    Skyrms B (1974) Introduzione alla logica induttiva. Il Mulino, BolognaGoogle Scholar
  43. 43.
    Salmon WS (1963) Logic. Prentice-Hall, Inc., Englewood CliffsGoogle Scholar
  44. 44.
    Federspil G, Vettor R (2001) La logica della diagnosi differenziale. Ann Ital Med Int 16:17–25PubMedGoogle Scholar
  45. 45.
    Rumiati R (1990) Giudizio e decisione. Il Mulino, BolognaGoogle Scholar
  46. 46.
    Rumiati R (1996) La decisione degli esperti. Il Mulino, BolognaGoogle Scholar
  47. 47.
    Eddy DM (1982) Probabilistic reasoning in clinical medicine: problems and opportunities. In: Kahneman D, Slovic P, Tversky A (eds) Judgment under uncertainty: heuristics and biases. Cambridge University Press, New York, pp 249–267Google Scholar
  48. 48.
    Crupi V, Gensini GF, Motterlini M (2006) La dimensione cognitiva dell’errore in medicina. Franco Angeli, MilanoGoogle Scholar
  49. 49.
    Redelmeier DA, Koehler DJ, Liberman V, Tversky A (1995) Probability judgment in medicine: discounting unspecified possibilities. Med Decis Mak 15:227–230CrossRefGoogle Scholar
  50. 50.
    Redelmeier DA, Shafrir E, Aujla PS (2001) The beguiling pursuit of more information. Med Decis Mak 21:376–381CrossRefGoogle Scholar

Copyright information

© SIMI 2008

Authors and Affiliations

  1. 1.Department of Medical and Surgical Sciences, Clinica Medica 3University of PaduaPaduaItaly

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