Rein Carrie
Department of Clinical Research and Leadership, the George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Adv Med Educ Pract. 2025 May 1;16:713-728. doi: 10.2147/AMEP.S496784. eCollection 2025.
In recent decades, improvements in diagnostic accuracy in medical cases have been minimal despite rapid advancements in technology. Moreover, in complex cases, diagnostic accuracy remains a significant challenge, often reflecting practices from the 18th and 19th centuries. This comprehensive narrative review explores how cognitive bias may act as a critical, yet neglected, factor contributing to the persistent diagnostic error rate.
A narrative review of the literature was conducted through a search of the George Washington University library databases and Google Scholar to identify studies related to physician cognition, complex medical diagnosis, and cognitive error.
This review synthesizes existing literature to propose a theoretical framework explaining how cognitive error, clinician cognition, tolerance of uncertainty, and attachment theory interact to influence the formation of cognitive bias at the cost of diagnostic accuracy and efficiency.
It is not only necessary for clinicians to focus on a patient's words, symptoms, or data to improve diagnostic accuracy, but also for clinicians to relate to others' distress through their own attachment styles: technology's critical blind spot. Clinicians with insecure attachment styles may struggle with metacognition, exhibit lower cognitive flexibility, have reduced tolerance for uncertainty, experience lower thresholds for cognitive load, and rely more heavily on heuristics, leading to an increased likelihood of cognitive error during complex medical cases. This theory provides a foundation for further research into how attachment influences clinician decision-making and diagnostic performance while also highlighting how medical education may reinforce these patterns.
近几十年来，尽管技术飞速发展，但医疗病例诊断准确性的提高微乎其微。此外，在复杂病例中，诊断准确性仍然是一项重大挑战，常常反映出18和19世纪的诊疗方式。这篇全面的叙述性综述探讨了认知偏差如何可能成为导致持续诊断错误率的一个关键但被忽视的因素。
通过搜索乔治华盛顿大学图书馆数据库和谷歌学术进行文献叙述性综述，以识别与医生认知、复杂医学诊断和认知错误相关的研究。
本综述综合现有文献，提出一个理论框架，解释认知错误、临床医生认知、对不确定性的容忍度和依恋理论如何相互作用，以诊断准确性和效率为代价影响认知偏差的形成。
临床医生不仅需要关注患者的言语、症状或数据以提高诊断准确性，还需要通过自身的依恋风格来理解他人的痛苦：这是技术的关键盲点。依恋风格不安全的临床医生可能在元认知方面存在困难，表现出较低的认知灵活性，对不确定性的容忍度降低，认知负荷阈值降低，并且更依赖启发式方法，从而在复杂医疗病例中导致认知错误的可能性增加。该理论为进一步研究依恋如何影响临床医生决策和诊断表现奠定了基础，同时也突出了医学教育可能强化这些模式的方式。
