Thammasitboon Satid, Cutrer William B
Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, W-6006, Houston, TX 77030.
Curr Probl Pediatr Adolesc Health Care. 2013 Oct;43(9):232-41. doi: 10.1016/j.cppeds.2013.07.003.
A significant portion of diagnostic errors arises through cognitive errors resulting from inadequate knowledge, faulty data gathering, and/or faulty verification. Experts estimate that 75% of diagnostic failures can be attributed to clinician diagnostic thinking failure. The cognitive processes that underlie diagnostic thinking of clinicians are complex and intriguing, and it is imperative that clinicians acquire explicit appreciation and application of different cognitive approaches to make decisions better. A dual-process model that unifies many theories of decision-making has emerged as a promising template for understanding how clinicians think and judge efficiently in a diagnostic reasoning process. The identification and implementation of strategies for decreasing or preventing such diagnostic errors has become a growing area of interest and research. Suggested strategies to decrease diagnostic error incidence include increasing clinician's clinical expertise and avoiding inherent cognitive errors to make decisions better. Implementing Interventions focused solely on avoiding errors may work effectively for patient safety issues such as medication errors. Addressing cognitive errors, however, requires equal effort on expanding the individual clinician's expertise. Providing cognitive support to clinicians for robust diagnostic decision-making serves as the final strategic target for decreasing diagnostic errors. Clinical guidelines and algorithms offer another method for streamlining decision-making and decreasing likelihood of cognitive diagnostic errors. Addressing cognitive processing errors is undeniably the most challenging task in reducing diagnostic errors. While many suggested approaches exist, they are mostly based on theories and sciences in cognitive psychology, decision-making, and education. The proposed interventions are primarily suggestions and very few of them have been tested in the actual practice settings. Collaborative research effort is required to effectively address cognitive processing errors. Researchers in various areas, including patient safety/quality improvement, decision-making, and problem solving, must work together to make medical diagnosis more reliable.
很大一部分诊断错误是由认知错误引起的，这些认知错误源于知识不足、数据收集错误和/或验证错误。专家估计，75%的诊断失败可归因于临床医生的诊断思维失误。临床医生诊断思维背后的认知过程复杂且引人入胜，临床医生必须明确认识并应用不同的认知方法，以便更好地做出决策。一种统一了多种决策理论的双过程模型已成为理解临床医生在诊断推理过程中如何高效思考和判断的一个有前景的模板。识别和实施减少或预防此类诊断错误的策略已成为一个越来越受关注和研究的领域。建议的降低诊断错误发生率的策略包括提高临床医生的临床专业知识，并避免固有的认知错误以更好地做出决策。仅专注于避免错误的干预措施可能对诸如用药错误等患者安全问题有效。然而，解决认知错误需要同样努力来扩展个体临床医生的专业知识。为临床医生提供认知支持以进行有力的诊断决策是减少诊断错误的最终战略目标。临床指南和算法提供了另一种简化决策并降低认知诊断错误可能性的方法。不可否认，解决认知处理错误是减少诊断错误中最具挑战性的任务。虽然存在许多建议的方法，但它们大多基于认知心理学、决策和教育方面的理论和科学。所提出的干预措施主要是建议，其中很少在实际临床环境中进行过测试。需要开展合作研究工作来有效解决认知处理错误。包括患者安全/质量改进、决策和问题解决等各个领域的研究人员必须共同努力，使医学诊断更加可靠。
