Service of General Internal Medicine, University Hospitals, Geneva, Switzerland.
Swiss Med Wkly. 2012 Oct 23;142:w13706. doi: 10.4414/smw.2012.13706. eCollection 2012.
Diagnostic errors account for more than 8% of adverse events in medicine and up to 30% of malpractice claims. Mechanisms of errors may be related to the working environment but cognitive issues are involved in about 75% of the cases, either alone or in association with system failures. The majority of cognitive errors are not related to knowledge deficiency but to flaws in data collection, data integration, and data verification that may lead to premature diagnostic closure. This paper reviews some aspects of the literature on cognitive psychology that help us to understand reasoning processes and knowledge organisation and summarises biases related to clinical reasoning. It reviews the strategies described to prevent cognitive diagnostic errors. Many approaches propose awareness and reflective practice during daily activities, but the improvement of the quality of training at the pre-graduate, postgraduate and continuous levels, by using evidence-based education, should also be considered. Several conditions must be fulfilled to increase the understanding, the prevention, and the correction of diagnostic errors related to clinical reasoning: physicians must be willing to understand their own reasoning and decision processes; training efforts should be provided during the whole continuum of a clinician's career; and the involvement of medical schools, teaching hospitals, and medical societies in medical education research should be increased to improve evidence about error prevention.
诊断错误在医学中占不良事件的 8%以上，占医疗事故索赔的 30%。错误的机制可能与工作环境有关，但认知问题在大约 75%的情况下都存在，无论是单独存在还是与系统故障一起存在。大多数认知错误与知识缺乏无关，而是与数据收集、数据整合和数据验证中的缺陷有关，这些缺陷可能导致过早做出诊断。本文回顾了一些认知心理学文献中的内容，这些内容帮助我们理解推理过程和知识组织，并总结了与临床推理相关的偏见。本文还回顾了为防止认知诊断错误而描述的策略。许多方法建议在日常活动中提高意识和进行反思性实践，但也应该考虑在本科、研究生和继续教育阶段使用基于证据的教育来提高培训质量。要增加对与临床推理相关的诊断错误的理解、预防和纠正，必须满足以下几个条件：医生必须愿意了解自己的推理和决策过程；应该在临床医生职业生涯的整个连续体中提供培训；医学院、教学医院和医学协会应该更多地参与医学教育研究，以提高有关预防错误的证据。
