Acta Diabetologica

, Volume 53, Issue 2, pp 169–175 | Cite as

“First, know thyself”: cognition and error in medicine

  • Fabrizio Elia
  • Franco Aprà
  • Andrea Verhovez
  • Vincenzo Crupi
Review Article


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.


Diagnostic errors Decision making Diagnosis Medical errors 


Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

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.

Informed Consent

All persons gave their informed consent prior to their inclusion in the study.


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Copyright information

© Springer-Verlag Italia 2015

Authors and Affiliations

  • Fabrizio Elia
    • 1
  • Franco Aprà
    • 1
  • Andrea Verhovez
    • 1
  • Vincenzo Crupi
    • 2
  1. 1.High Dependency UnitSan Giovanni Bosco HospitalTurinItaly
  2. 2.Department of Philosophy and Education, Center for Logic, Language, and CognitionUniversity of TurinTurinItaly

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