week 6

Diagnostic Excellence 03: 16-year-old female with pelvic pain User: Daniela Fernandez Email: [email protected] Date: February 17, 2021 4:35PM

Learning Objectives

The student should be able to:

Define analytic and nonanalytic decision-making processes. Discuss how both analytic and nonanalytic decision-making processes may lead to diagnostic error. Describe three different systems factors that contribute to diagnostic error. Communicate safely and accurately with team members or health care providers about diagnostic errors discovered during handovers. Discuss the role of metacognition in preventing error.

Clinical Reasoning

Prioritized Differential Diagnosis with Evidence—A Marriage of System 1 and 2

A helpful practice when approaching a clinical problem is to create a prioritized differential diagnosis (from most likely to least likely) and providing evidence for and against each item on the differential. Previously developed illness scripts (system 1 pattern recognition) help inform the differential, and meticulous weighing of evidence (system 2 analytics) explain what is more likely or less likely to be occurring.

Learning From Error—Reflection

Reflecting on the causes of a diagnostic error can help clinicians process and debrief from the emotional aftermath of an error (if unaddressed it can lead to the "second victim effect" and impact providers' wellbeing ) and also allows the opportunity to identify personal and systems-level cognitive bias mitigation strategies and quality improvement opportunities.

Heuristics—Being a Cognitive Load

Over time, we develop mental shortcuts or heuristics which help us more quickly and easily make sense of information. Heuristics can be helpful and ease our cognitive burden, but they can also be prone to biases.

Error Disclosure

After an error has occurred, it is best to disclose the error to the patient (and family if applicable) as soon as possible. After an error has occurred, report the error through your institution's reporting system.

References

Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005 Jul 11;165(13):1493-9.

Hayward RA. Counting deaths due to medical errors. JAMA. 2002 Nov 20;288(19):2404-5;

Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf. 2014 Sep;23(9):727-31.

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