diagnostic error - new names for old phenomena

David Woods woods.2 at OSU.EDU
Tue Dec 17 14:28:25 UTC 2013


A note for scholarship purposes —  new names for old phenomena

the phenomenon of difficulties and failures to revise assessments has a long, long history in the study of cognition and is known as ‘fixation’  though it has always had a variety of other labels as well.  

it is part of a process ‘framing' and 're-framing’  that also has very old roots in the study of cognition.

past studies have shown revising and reframing is a very difficult form of cognitive work and assisting in re-framing and revising assessments is a critical aspect of designing a cognitive system (note this finding applies across scales of people, groups, units, organizations, for example, in the lead up to the Columbia space shuttle accident). I first studied this pattern in nuclear power emergencies 30 plus years ago. What was interesting in the data was how difficult it is to revise a mis-assessment or to revise a once plausible assessment as new evidence comes in.  In summary, research consistently shows that revising assessments successfully requires a new way of looking at previous facts. We can help provide this “fresh” view: (a) by bringing in people new to the situation, (b) through interactions across diverse groups with diverse knowledge and tools, (c) through new visualizations which capture the big picture and re-organize data into different perspectives. 

the topics touched on in the discussions relate to a wide variety of general findings and models about cognitive work.  finding a way to ground the discussion on results on cognitive work is difficult but might be valuable.  
 
for example, models of the cognitive work associated with revision of assessments exist and are based on adductive reasoning.  The models of abduction, expanded for the context of work situations like health care, provide an integrative framework for many of the factors that have come up in the discussions and provide a technical foundation for historical aspects of how medicine has approached diagnosis.  

if people are interested in this history they might find it valuable to start with recent summaries on reframing and fixation.  See Gary Klein on sensemaking and problem detection and chapters 8/9 on anomaly response in my book Joint Cognitive Systems: Patterns in Cognitive Systems Engineering.  I can email these papers and chapters if people would like.

David




-------- Original Message --------
Subject: Re: [IMPROVEDX] The patient experience of diagnostic error
From: Leonard Berlin <lberlin at LIVE.COM>
Date: Sun, October 20, 2013 7:32 pm
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG


In his book a few years ago, Jerome Groopman called this "diagnosis momentum."  In radiology we call it the "alliterative error." Once a diagnosis is in play, it is very difficult to convince the physician to consider an alternative diagnosis.

Len Berlin






David Woods, PhD  木材
Releasing the Adaptive Power of Human Systems

• Lead, Initiative on Complexity in Natural, Social & Engineered Systems
• Co-Director, C/S/E/L Cognitive Systems Engineering Laboratory 


Department of Integrated Systems Engineering 
The Ohio State University
290 Baker Systems | 1971 Neil Ave Columbus, OH 43210
614-946-0123 
woods.2 at osu.edu

• Past-President and Executive Committee, Resilience Engineering Association


On Dec 16, 2013, at 3:45 PM, Malone, Edward J. III, M.D. <Malone.Edward at MAYO.EDU> wrote:

> -------- Original Message --------
> Subject: Re: [IMPROVEDX] The patient experience of diagnostic error
> From: Leonard Berlin <lberlin at LIVE.COM>
> Date: Sun, October 20, 2013 7:32 pm
> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> 
> 
> In his book a few years ago, Jerome Groopman called this "diagnosis momentum."  In radiology we call it the "alliterative error." Once a diagnosis is in play, it is very difficult to convince the physician to consider an alternative diagnosis.
> 
> Len Berlin









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