Elia Fabrizio, Aprà Franco, Verhovez Andrea, Crupi Vincenzo
High Dependency Unit, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, 10154, Turin, Italy.
Department of Philosophy and Education, Center for Logic, Language, and Cognition, University of Turin, Turin, Italy.
Acta Diabetol. 2016 Apr;53(2):169-75. doi: 10.1007/s00592-015-0762-8. Epub 2015 May 5.
Although error is an integral part of the world of medicine, physicians have always been little inclined to take into account their own mistakes and the extraordinary technological progress observed in the last decades does not seem to have resulted in a significant reduction in the percentage of diagnostic errors. The failure in the reduction in diagnostic errors, notwithstanding the considerable investment in human and economic resources, has paved the way to new strategies which were made available by the development of cognitive psychology, the branch of psychology that aims at understanding the mechanisms of human reasoning. This new approach led us to realize that we are not fully rational agents able to take decisions on the basis of logical and probabilistically appropriate evaluations. In us, two different and mostly independent modes of reasoning coexist: a fast or non-analytical reasoning, which tends to be largely automatic and fast-reactive, and a slow or analytical reasoning, which permits to give rationally founded answers. One of the features of the fast mode of reasoning is the employment of standardized rules, termed "heuristics." Heuristics lead physicians to correct choices in a large percentage of cases. Unfortunately, cases exist wherein the heuristic triggered fails to fit the target problem, so that the fast mode of reasoning can lead us to unreflectively perform actions exposing us and others to variable degrees of risk. Cognitive errors arise as a result of these cases. Our review illustrates how cognitive errors can cause diagnostic problems in clinical practice.
尽管错误是医学领域不可或缺的一部分，但医生们一直不太愿意考虑自己的错误，而且过去几十年里观察到的非凡技术进步似乎并没有使诊断错误的百分比显著降低。尽管在人力和经济资源方面投入巨大，但诊断错误率未能降低，这为认知心理学（旨在理解人类推理机制的心理学分支）发展带来的新策略铺平了道路。这种新方法让我们意识到，我们并非完全理性的主体，无法基于逻辑和概率上合理的评估来做决策。在我们身上，两种不同且大多相互独立的推理模式并存：一种快速或非分析性推理，它往往很大程度上是自动且快速反应的；另一种缓慢或分析性推理，它能给出有合理依据的答案。快速推理模式的一个特点是使用标准化规则，即“启发式”。启发式在很大比例的情况下能引导医生做出正确选择。不幸的是，存在这样的情况，即触发的启发式与目标问题不匹配，以至于快速推理模式会导致我们不假思索地采取行动，使我们自己和他人面临不同程度的风险。这些情况就会导致认知错误。我们的综述阐述了认知错误如何在临床实践中引发诊断问题。
