“First, know thyself”: cognition and error in medicine
- 536 Downloads
Although error is an integral part of the world of medicine, physicians have always been little inclined to take into account their own mistakes and the extraordinary technological progress observed in the last decades does not seem to have resulted in a significant reduction in the percentage of diagnostic errors. The failure in the reduction in diagnostic errors, notwithstanding the considerable investment in human and economic resources, has paved the way to new strategies which were made available by the development of cognitive psychology, the branch of psychology that aims at understanding the mechanisms of human reasoning. This new approach led us to realize that we are not fully rational agents able to take decisions on the basis of logical and probabilistically appropriate evaluations. In us, two different and mostly independent modes of reasoning coexist: a fast or non-analytical reasoning, which tends to be largely automatic and fast-reactive, and a slow or analytical reasoning, which permits to give rationally founded answers. One of the features of the fast mode of reasoning is the employment of standardized rules, termed “heuristics.” Heuristics lead physicians to correct choices in a large percentage of cases. Unfortunately, cases exist wherein the heuristic triggered fails to fit the target problem, so that the fast mode of reasoning can lead us to unreflectively perform actions exposing us and others to variable degrees of risk. Cognitive errors arise as a result of these cases. Our review illustrates how cognitive errors can cause diagnostic problems in clinical practice.
KeywordsDiagnostic errors Decision making Diagnosis Medical errors
Conflict of interest
The authors declare that they have no conflict of interest.
All human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki.
Human and Animal Rights
This article does not contain any studies with human or animal subjects performed by the any of the authors.
All persons gave their informed consent prior to their inclusion in the study.
- 1.Kohn LTC, Donaldson JM, Molla S (eds) (2000) To err is human: building a safer health system. National Academy Press, WashingtonGoogle Scholar
- 5.Gawande A (2009) The Checklist manifesto—how to get things right. Metropolitan Books, New YorkGoogle Scholar
- 15.Kahneman D (2011) Thinking fast and slow. Macmillan, New YorkGoogle Scholar
- 20.Gigerenzer G (2008) Gut feelings: the intelligence of the unconscious. Viking Press, New YorkGoogle Scholar
- 21.Gladwell M (2005) Blink: The power of thinking without thinking. Little, Brown and Co, New YorkGoogle Scholar
- 23.Kahneman D, Frederick S (2002) Representativeness revisited: attribute substitution in intuitive judgment. In: Gilovich T, Griffin DW, Kahneman D (eds) Heuristics and biases. Cambridge University Press, New York, pp 49–81Google Scholar
- 24.Taleb NN (2010) The black swan: the impact of the highly improbable. Random House, New YorkGoogle Scholar
- 38.American Child Health Association Research Division (1934) Physical defects: the pathway to correction. American Child Health Association, New YorkGoogle Scholar
- 40.Crupi V (2013) Confirmation. The Stanford encyclopedia of philosophy. EN Zalta (ed) http://plato.stanford.edu/entries/confirmation/