The Role of Cognitive Biases in Medical Errors: A Review of the Literature, Concepts and Definitions
akhlāq-i pizishkī i.e., Medical Ethics,
Vol. 15 No. 46 (1400),
7 Khordad 2021
,
Page 1-15
https://doi.org/10.22037/mej.v15i46.25365
Abstract
Background and Aim: Medical errors are a significant burden on the health care system and considered as a fundamental challenge for physician, ethic and health care policymakers. Most of these errors in diagnosis are associated with defects in clinical reasoning. Currently, investigating and identifying cognitive factors involved in these errors are taken into consideration.
Materials and Methods: In this narrative review, the history of medical errors and cognitive biases in clinical diagnoses will be explained. For this purpose, 400 articles published between 1900 to 2018, were extracted from four databases PubMed, SCOPUS, Google Scholar and Oxford.
Ethical Considerations: In this narrative study, we tried to follow the principles of scientific writing, trusteeship and honesty in using resources.
Findings: Research literature in this field suggests three hypotheses triple processing models, system one and two of information processing, and intuitive-analytical thinking to explain medical errors and defects in clinical diagnoses, so that cognitive biases are considered one of the most basic origins of defects in the process of clinical reasoning. Accordingly, the findings are developed in three sections: Clinical reasoning and error in diagnosis, dual processing models and cognitive bias.
Conclusion: This narrative review revealed that it is necessary to address the cognitive aspects of clinical errors as long as the common and well-known causes of medical errors in health care.
Cite this article as: Saeedi MT, Arbabi M. The Role of Cognitive Biases in Medical Errors: A Review of the Literature, Concepts and Definitions. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e14.
- Medical Errors; Cognitive Biases; Dual Processing; Decision Making
How to Cite
References
Redelmeier DA. The cognitive psychology of missed diagnoses. Ann Intern Med. 2005; 142(2): 115-120.
Croskerry P. From Mindless to Mindful Practice-Cognitive Bias and Clinical Decision Making. N Engl J Med. 2013; 368: 2445-2448.
Berner ES, Graber ML. Overconfidence as a Cause of Diagnostic Error in Medicine. Am J Med. 2008; 121(5): S2-S23.
Kassirer JP. Diagnostic Reasoning. Ann Intern Med. 1989; 110(11): 893-900.
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003; 78(8): 775-780.
Graber ML, Franklin N, Gordon R. Diagnostic Error in Internal Medicine. Arch Intern Med. 2005; 165(16): 1493-1499.
Singh H, Giardina TD, Meyer AND, Forjuoh SN, Reis MD, Thomas EJ. Types and origins of diagnostic errors in primary care settings. JAMA Intern Med. 2013; 173(6): 418-425.
Ittenbach RF, Gupta R. Review of Jeremy Sugarman. Edited by Daniel SP. Methods in Medical Ethics. 2nd ed. AJOB Prim Res. 2011; 2(3): 47-49.
Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000.
Balogh EP, Miller BT, Ball JRE. Improving Diagnosis in Health Care. Washington, DC: National Academies Press; 2015.
Andel C, Davidow SL, Hollander M, Moreno DA. The Economics of Health Care Quality and Medical Errors. J Health Care Finance. 2012; 39(1): 39-50.
Weingart SN, Wilson RMcL, Gibberd RW, Harison B. Epidemiology of medical error. Br Med J. 2000; 320(7237): 774-777.
Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991; 266(20): 2847-2851.
Stripe SC, Best LG, Cole-Harding S, Fifield B, Talebdoost F. Aviation Model Cognitive Risk Factors Applied to Medical Malpractice Cases. J Am Board Fam Med. 2006; 19(6): 627-632.
Van Den Berge K, Mamede S. Cognitive diagnostic error in internal medicine. Eur J Intern Med. 2013; 24(6): 525-529.
Shojania KG, Burton EC, McDonald KM, Goldman L. Changes in Rates of Autopsy-Detected Diagnostic Errors Over Time. JAMA. 2003; 289(21): 2849-2856.
Mamede S, Gog TV, Berge KV, Rikers RM, Saase Jl, Guldner CV. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA. 2010; 304(11): 1198-1203.
Elstein AS, Shulman LS, Saprafka SA. Medical problem solving: Ten-year retrospective. Eval Health Prof. 1990; 13(1): 5-36.
Sweller J. Cognitive Load During Problem Solving: Effects on Learning. Cogn Sci. 1988; 12(2): 257-285.
Neufeld VR, Normon GR, Felghner JW, Barrows HS. Clinical problem‐solving by medical students: a cross‐sectional and longitudinal analysis. Med Educ. 1981; 15(5): 315-322.
Norman G. Research in clinical reasoning: Past history and current trends. Med Educ. 2005; 39(4): 418-427.
Pelaccia T, Tardif J, Triby E, Ammirati C, Bertrand C, Dory V, et al. How and when do expert emergency physicians generate and evaluate diagnostic hypotheses? A qualitative study using head-mounted video cued-recall interviews. Ann Emerg Med. 2014; 64(6): 575-585.
Tversky A, Kahneman D. Judgment under Uncertainty: Heuristics and Biases. Science. 1974; 185(4157): 1124-1131.
Blumenthal-Barby JS, Krieger H. Cognitive biases and heuristics in medical decision making: A critical review using a systematic search strategy. Med Decis Mak. 2015; 35(4): 539-557.
Norman GR, Monteiro SD, Sherbino J, Ilgen JS, Schmidt HG, Mamede S. The Causes of Errors in Clinical Reasoning: Cognitive Biases, Knowledge Deficits, and Dual Process Thinking. Acad Med. 2017; 92(1): 23-30.
Phua DH, Tan NC. Cognitive aspect of diagnostic errors. Ann Acad Med Singapore. 2013; 42(1): 33-41.
Elstein AS. Thinking about diagnostic thinking: A 30-year perspective. Adv in Heal Sci Educ. 2009; 14(1 SUPPL): 7-18.
Norman G. Dual processing and diagnostic errors. Adv in Heal Sci Educ. 2009; 14(1 SUPPL): 37-49.
Croskerry P. Clinical cognition and diagnostic error: Applications of a dual process model of reasoning. Adv in Heal Sci Educ. 2009; 14(1 SUPPL): 27-35.
Sloman SA. The empirical case for two systems of reasoning. Psychol Bull. 1996; 119(1): 3-22.
Kahneman D. Thinking, Fast and Slow. New York, NY: Farrar, Strauss and Giroux; 2011. p.533.
Bornstein BH, Emler AC. Rationality in medical decision making: A review of the literature on doctors’ decision-making biases. J Eval Clin Pract. 2001; 7(2): 97-107.
Croskerry P. Achieving quality in clinical decision making: Cognitive strategies and detection of bias. Acad Emerg Med. 2002; 9(11): 1184-1204.
Hall KH. Reviewing intuitive decision-making and uncertainty: The implications for medical education. Med Educ. 2002; 36(3): 216-224.
Norman GR, Eva KW. Diagnostic error and clinical reasoning. Med Educ. 2010; 44(1): 94-100.
Evans JSBT, Stanovich KE. Dual-Process Theories of Higher Cognition: Advancing the Debate. Perspect Psychol Sci. 2013; 8(3): 223-241.
Logan GD. Toward an Instance Theory of Automatization. Psychol Rev. 1988; 95(4): 492-527.
Itri JN, Patel SH. Heuristics and cognitive error in medical imaging. AJR. 2018; 210(5): 1097-1105.
Hunzeker A, Amin R. Teaching Cognitive Bias in a Hurry: Single-Session Workshop Approach for Psychiatry Residents and Students. Med Ed Portal. 2016; 12: 10451.
Arbabi M, Mostafazade Davani B, Sadeghi Najafabadi M, Nejati Safa AA, Ghazizadeh Z, Javadi SH. The Effect of Hindsight Bias on Psychiatrists’ Clinical Judgment: A Randomized Controlled Trials. J Psychiatry. 2017; 20(6).
Hussain A, Oestreicher J. Clinical decision-making: Heuristics and cognitive biases for the ophthalmologist. Surv Ophthalmol. 2018; 63(1): 119-124.
Koehler K., Jacoby C. Schneider-oriented psychiatric diagnosis in Germany compared with New York and London. Compr Psychiat. 1978; 19(1): 19-26.
Ely JW, Graber ML, Croskerry P. Checklists to reduce diagnostic errors. Acad Med. 2011; 86(3): 307-313.
Ross S, Moffat K, McConnachie A, Gordon J, Wilson P. Sex and attitude: A randomized vignette study of the management of depression by general practitioners. Br J Gen Pract. 1999; 49(438): 17-21.
Perneger TV, Agoritsas T. Doctors and patients’ susceptibility to framing bias: A randomized trial. J Gen Intern Med. 2011; 26: 1411-1417.
Yee LM, Liu LY, Grobman WA. The relationship between obstetricians’ cognitive and affective traits and their patients’ delivery outcomes. Am J Obstet Gynecol. 2014; 211(6): 692.e1-692.e6.
Ogdie AR, Reilly JB, Pang WG, Keddem S, Barg FK, Von Feldt JM, et al. Seen through their eyes: Residents’ reflections on the cognitive and contextual components of diagnostic errors in medicine. Acad Med. 2012; 87(10): 1361-1367.
Stiegler MP, Ruskin KJ. Decision-making and safety in anesthesiology. Curr Opin Anaesthesiol. 2012; 25(6): 724-729.
Crowley RS, Legowski E, Medvedeva O, Reitmeyer K, Tseytlin E, Castine M, et al. Automated detection of heuristics and biases among pathologists in a computer-based system. Adv in Heal Sci Educ. 2013; 18(3): 343-363.
Jenkins MM, Youngstorm EA. A Randomized Controlled Trial of Cognitive Debiasing Improves Assessment and Treatment Selection for Pediatric Bipolar Disorder. J Consult Clin Psychol. 2016; 84(4): 323-333.
Schmidt HG, Mamede S, Van Den Berge K, Van Gog T, Van Saase JLCM, Rikers RMJP. Exposure to media information about a disease can cause doctors to misdiagnose similar-looking clinical cases. Acad Med. 2014; 89(2): 285-291.
Renner CH, Renner MJ. But I Thought I Knew That: Using Confidence Estimation as a Debiasing Technique to Improve Classroom Performance. Appl Cogn Psychol. 2001; 15(1): 23-32.
Kovacs G, Croskerry P. Clinical decision making: An emergency medicine perspective. Acad Emerg Med. 1999; 6(9): 947-952.
Fischhoff B. Hindsight is not equal Foresight: The Effect of Outcome Knowledge on Judgment Under Uncertainty. BMJ Qual Saf. 1975; 1(3): 288-299.
Peel M. Human rights and medical ethics. J R Soc Med. 2005; 98: 171-173.
Klein JG. Five pitfalls in decisions making about diagnosis and prescribing. Br Med J. 2005; 330: 781.
O’sullivan ED, Schofield S. Cognitive bias clinical medicine. J R Coll Physicians Edinb. 2018; 48(3): 225-231.
- Abstract Viewed: 660 times