scholarly journals The psychology of diagnostic error

2015 ◽  
Vol 8 (3) ◽  
pp. 91-98
Author(s):  
L. Zwaan
Keyword(s):  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Diagnostic Process ◽  
Cognitive Errors ◽  
System 2 ◽  
System 1 ◽  
Analytic Reasoning

Diagnostic errors in medicine occur frequently and the consequences for the patient can be severe. Cognitive errors as well as system related errors contribute to the occurrence of diagnostic error, but it is generally accepted that cognitive errors are the main contributor. The diagnostic reasoning process in medicine, is an understudied area of research. One reason is because of the complexity of the diagnostic process and therefore the difficulty to measure diagnostic errors and the causes of diagnostic error. In this paper, I discuss some of the complexities of the diagnostic process. I describe the dual-process theory, which defines two reasoning modes, 1. a fast, automatic and unconscious reasoning mode called system 1, and a slow and analytic reasoning mode called system 2. Furthermore, the main cognitive causes of diagnostic error are described.

Cognitive Structure of Moral Reasoning, Development, and Evolution With Age and Pathology

2020 ◽  
pp. 30-57
Author(s):  
Veronique Salvano-Pardieu ◽  
Leïla Oubrahim ◽  
Steve Kilpatrick
Keyword(s):  
Moral Judgment ◽  
Cognitive Structure ◽  
Autism Spectrum ◽  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Moral Orientation ◽  
System 2 ◽  
The Difference ◽  
System 1

This chapter presents research on moral judgment from the beginning of the 20th century to the present day. First, the authors will present the contribution of Piaget and Kohlberg's work on moral development from childhood to adulthood as well as the work of Gilligan on moral orientation and the difference observed between men and women. Then, the authors will analyze underlying structures of moral judgment in the light of the Dual Process Theory with two systems: system 1: quick, deontological, emotional, intuitive, automatic, and system 2: slow, utilitarian, rational, controlled, involved in human reasoning. Finally, the model of Dual Process Theory will be confronted with data from moral judgment experiments, run on elderly adults with Alzheimer's disease, teenagers with Autism Spectrum Disorder, and children and teenagers with intellectual disability in order to understand how cognitive impairment affects the structures and components of moral judgment.

Freud's dual process theory and the place of the a-rational

2003 ◽  
Vol 26 (4) ◽  
pp. 527-528 ◽  
Author(s):  
Linda A. W. Brakel ◽  
Howard Shevrin
Keyword(s):  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Rational System ◽  
Process Theories ◽  
System 2 ◽  
Dual Process Theories ◽  
System 1 ◽  
Evolutionary Fitness

In this commentary on Stanovich & West (S&W) we call attention to two points: (1) Freud's original dual process theory, which antedates others by some seventy-five years, deserves inclusion in any consideration of dual process theories. His concepts of primary and secondary processes (Systems 1 and 2, respectively) anticipate significant aspects of current dual process theories and provide an explanation for many of their characteristics. (2) System 1 is neither rational nor irrational, but instead a-rational. Nevertheless, both the a-rational System 1 and the rational System 2 can each have different roles in enhancing evolutionary fitness. Lastly, System 1 operations are incorrectly deemed “rational” whenever they increase evolutionary fitness.

scholarly journals Mind the overlap: how system problems contribute to cognitive failure and diagnostic errors

Diagnosis ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 151-156 ◽  
Author(s):  
Ashwin Gupta ◽  
Molly Harrod ◽  
Martha Quinn ◽  
Milisa Manojlovich ◽  
Karen E. Fowler ◽  
...  
Keyword(s):  
Information Processing ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Organizational Structures ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Cognitive Errors ◽  
Data Verification ◽  
Consulting Services ◽  
Cognitive Failure

Abstract Background Traditionally, research has examined systems- and cognitive-based sources of diagnostic error as individual entities. However, half of all errors have origins in both domains. Methods We conducted a focused ethnography of inpatient physicians at two academic institutions to understand how systems-based problems contribute to cognitive errors in diagnosis. Medicine teams were observed on rounds and during post-round work after which interviews were conducted. Field notes related to the diagnostic process and the work system were recorded, and findings were organized into themes. Using deductive content analysis, themes were categorized based on a published taxonomy to link systems-based contributions and cognitive errors such as faulty data gathering, information processing, data verification and errors associated with multiple domains. Results Observations, focus groups and interviews of 10 teams were conducted between January 2016 and April 2017. The following themes were identified: (1) challenges with interdisciplinary communication and communication within the electronic medical record (EMR) contributed to faulty data gathering; (2) organizational structures such as the operation of consulting services in silos promoted faulty information processing; (3) care handoffs led to faulty data verification and (4) interruptions, time constraints and a cluttered physical environment negatively influenced multiple cognitive domains. Conclusions Systems-based factors often facilitate and promote cognitive problems in diagnosis. Linking systems-based contributions to downstream cognitive impacts and intervening on both in tandem may help prevent diagnostic errors.

Dispatch information affects diagnosis in paramedics: An experimental study of applied dual-process theory

2021 ◽  
Author(s):  
Toby Keene ◽  
Kristen Pammer ◽  
Bill Lord ◽  
Carol Shipp
Keyword(s):  
Experimental Study ◽  
Acute Coronary Syndrome ◽  
Secondary Task ◽  
Time Pressure ◽  
Diagnostic Error ◽  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Coronary Syndrome ◽  
Self Reports

Introduction. Previous research has shown that paramedics form intuitive impressions based on limited ‘pre-arrival’ dispatch information and this subsequently affects their diagnosis. However, this observation has never been experimentally studied. Method. This was an experimental study of 83 Australian undergraduate paramedics and 65 Australian paramedics with median 14 years’ experience (Range: 1 – 32 years). Participants responded to written vignettes in two parts that aimed to induce an intuitive impression by placing participants under time pressure and with a secondary task, followed by a diagnosis made without distraction or time pressure. The vignettes varied the likelihood of Acute Coronary Syndrome (ACS), and measured self-reports of typicality and confidence. Answer fluency, which is the ease with which the answer comes to mind, was also measured.Results. There was a difference in the proportion of participants diagnosing ACS according to what pre-arrival information was seen (.85 [95%CI: .78, .90] vs .74 [95%CI: .66, .81]; p = .03). Paramedics with greater than 14 years’ experience, were more likely to be affected by pre-arrival information in their diagnosis (.94 [78, .99] vs .67 [95%CI .48, .81]; p = .01). Answer fluency and confidence predicted impression, while the impression and confidence predicted final diagnosis.Conclusion. We have experimentally shown that pre-arrival information can affect subsequent diagnosis, increasing the chance of diagnostic error. The most experienced paramedics were most likely to be affected.

Reflective Knowledge

2018 ◽  
Author(s):  
Chienkuo Mi ◽  
Shane Ryan
Keyword(s):  
Extended Cognition ◽  
Dual Process ◽  
Dual Process Theory ◽  
Process Theory ◽  
Reflective Knowledge ◽  
Epistemological Disjunctivism ◽  
Recent Account

In this paper, we defend the claim that reflective knowledge is necessary for extended knowledge. We begin by examining a recent account of extended knowledge provided by Palermos and Pritchard (2013). We note a weakness with that account and a challenge facing theorists of extended knowledge. The challenge that we identify is to articulate the extended cognition condition necessary for extended knowledge in such a way as to avoid counterexample from the revamped Careless Math Student and Truetemp cases. We consider but reject Pritchard’s (2012b) epistemological disjunctivism as providing a model for doing so. Instead, we set out an account of reflection informed by Confucianism and dual-process theory. We make the case that reflective knowledge offers a way of overcoming the challenge identified. We show why such knowledge is necessary for extended knowledge, while building on Sosa’s (2012) account of meta-competence.

Re-thinking morbidity and mortality

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Sumner Abraham ◽  
Andrew Parsons ◽  
Brian Uthlaut ◽  
Peggy Plews-Ogan
Keyword(s):  
Cognitive Biases ◽  
Diagnostic Errors ◽  
Dual Process ◽  
Morbidity And Mortality ◽  
Dual Process Theory ◽  
Habits Of Mind ◽  
Thought Processes ◽  
University Of Virginia ◽  
Self Reflection ◽  
The University

AbstractDespite the breadth of patient safety initiatives, physicians talking about their mistakes to other physicians is a difficult thing to do. This difficulty may be exacerbated by a limited exposure to how to analyze and discuss mistakes and respond in a productive way. At the University of Virginia, we recognized the importance of understanding cognitive biases for residents in both their clinical and personal professional development. We re-designed our resident led morbidity and mortality (M&M) conference using a model that integrates dual-process theory and metacognition to promote informed reflection and analysis of cognitive diagnostic errors. We believe that structuring M&M in this way builds a culture that encourages reflection together to learn our most difficult diagnostic errors and to engage in where our thought processes went wrong. In slowly building this culture, we hope to inoculate residents with the habits of mind that can best protect them from harmful biases in their clinical reasoning while instilling a culture of self-reflection.

scholarly journals Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation

2021 ◽  
pp. bmjqs-2020-011593
Author(s):  
Traber D Giardina ◽  
Saritha Korukonda ◽  
Umber Shahid ◽  
Viralkumar Vaghani ◽  
Divvy K Upadhyay ◽  
...  
Keyword(s):  
Medical Record ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Healthcare Organisation ◽  
Safety Concerns ◽  
Patient Complaints ◽  
Malpractice Claims

BackgroundPatient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.ObjectiveTo systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.MethodsWe reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.ResultsIn cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.ConclusionsAnalysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.

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