- The decision making process - automatic, subconscious processing versus analytical type thinking
- The cognitive, system and patient related factors that contribute to diagnostic error
- Recognising and reducing the risk of diagnostic error
This framework promotes reflective safe diagnostic process by increasing clinician knowledge and awareness of the cognitive risks associated with decision making during diagnosis. The strategies outlined provide support, structure and guidance to decision making. This ensures all the key factors have been considered for each clinical presentation and the worst case scenario is flagged and ruled out.
Jess’ Story: Do No harm (11 min YouTube video)
This video describes the tragic journey of a teenager who died following a diagnostic error and the cognitive and system related breakdowns that led to the missed recognition of long QT syndrome. There were a series of missed opportunities through multiple episodes of care over several years in which the correct diagnosis could have been identified.
Onthewards: Episode 85 - Diagnostic Errors (24 min podcast)
On the wards is a series of educational podcasts, providing interview style discussion relating to topical issues in the clinical environment. This episode discusses the common causes of diagnostic error and explores the decision making process and some of the common cognitive biases in clinical practice, providing some practical strategies to help reduce error within a team.
The following articles provide a comprehensive overview of current thinking relating to the extent and impact of diagnostic error in clinical practice. The system and cognitive factors contributing to diagnostic error are examined and explored, highlighting the frequently recurring themes identified in diagnostic error.
- Graber M, Franklin N, Gordan R. Diagnostic Error in Internal Medicine. 2005, Arch Intern Med, Vol. 165, 1493 – 1499.
- Croskerry P. From Mindless to Mindful Practice - Cognitive Bias and Clinical Decision Making. The New England Journal of Medicine, 2013; 368:26, 2445 – 2448.
- Croskerry P, Singhal G, Mamede S. Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ Quality and Safety. 2013; 0:1–7.
- Schiff G. Diagnosis and diagnostic errors: time for a new paradigm. BMJ Quality and Safety. 2014; 23:1–3.