From the Departments of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628.
Radiographics. 2018 Jan-Feb;38(1):236-247. doi: 10.1148/rg.2018170107. Epub 2017 Dec 1.
Medical errors are a leading cause of morbidity and mortality in the medical field and are substantial contributors to medical costs. Radiologists play an integral role in the diagnosis and care of patients and, given that those in this field interpret millions of examinations annually, may therefore contribute to diagnostic errors. Errors can be categorized as a "miss" when a primary or critical finding is not observed or as a "misinterpretation" when errors in interpretation lead to an incorrect diagnosis. In this article, the authors describe the cognitive causes of such errors in diagnostic medicine, specifically in radiology. Recognizing the cognitive processes that radiologists use while interpreting images should improve one's awareness of the inherent biases that can impact decision making. The authors review the common biases that impact clinical decisions, as well as strategies to counteract or minimize the potential for misdiagnosis. System-level processes that can be implemented to minimize cognitive errors are reviewed, as well as ways to implement personal changes to minimize cognitive errors in daily practice. RSNA, 2017.
医疗差错是医疗领域发病率和死亡率的主要原因,也是医疗成本的重要组成部分。放射科医生在患者的诊断和护理中起着不可或缺的作用,鉴于该领域的医生每年要解读数百万份检查报告,他们可能会导致诊断错误。错误可分为“漏诊”,即未观察到主要或关键的发现,或“误诊”,即解释错误导致错误的诊断。在本文中,作者描述了诊断医学中此类错误(特别是放射科)的认知原因。认识到放射科医生在解读图像时使用的认知过程,应该可以提高人们对固有偏见的认识,这些偏见会影响决策。作者回顾了影响临床决策的常见偏见,以及对抗或最小化误诊可能性的策略。还回顾了可以实施的系统级流程,以最小化认知错误,以及在日常实践中实施个人变更以最小化认知错误的方法。RSNA,2017。