Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
World Neurosurg. 2014 Jul-Aug;82(1-2):e21-9. doi: 10.1016/j.wneu.2014.03.030. Epub 2014 Mar 17.
During the last 2 decades, there has been a shift in the U.S. health care system towards improving the quality of health care provided by enhancing patient safety and reducing medical errors. Unfortunately, surgical complications, patient harm events, and malpractice claims remain common in the field of neurosurgery. Many of these events are potentially avoidable. There are an increasing number of publications in the medical literature in which authors address cognitive errors in diagnosis and treatment and strategies for reducing such errors, but these are for the most part absent in the neurosurgical literature. The purpose of this article is to highlight the complexities of medical decision making to a neurosurgical audience, with the hope of providing insight into the biases that lead us towards error and strategies to overcome our innate cognitive deficiencies. To accomplish this goal, we review the current literature on medical errors and just culture, explain the dual process theory of cognition, identify common cognitive errors affecting neurosurgeons in practice, review cognitive debiasing strategies, and finally provide simple methods that can be easily assimilated into neurosurgical practice to improve clinical decision making.
在过去的 20 年里，美国医疗保健系统发生了转变，通过提高患者安全性和减少医疗失误来提高医疗服务质量。不幸的是，手术并发症、患者伤害事件和医疗事故索赔在神经外科学领域仍然很常见。这些事件中有许多是可以预防的。越来越多的医学文献中，作者针对诊断和治疗中的认知错误以及减少这些错误的策略进行了探讨，但这些在神经外科学文献中大部分是缺失的。本文的目的是向神经外科学术界强调医疗决策的复杂性，希望能深入了解导致我们犯错的偏见，并提供克服固有认知缺陷的策略。为了实现这一目标，我们回顾了关于医疗错误和公正文化的现有文献，解释了认知的双重加工理论，确定了在实践中影响神经外科医生的常见认知错误，回顾了认知去偏差策略，最后提供了一些简单的方法，可以很容易地融入神经外科实践中，以改善临床决策。
