Wrongology

Jain, Bimal P.,M.D. BJAIN at PARTNERS.ORG
Mon Jan 11 20:03:40 UTC 2016


Mark, thanks for attaching the extremely interesting Times book review.
We shall make progress in reducing diagnostic errors despite our cognitive biases, I suggest, by first understanding how diagnosis is performed in actual practice. Recently, I examined 50 CPCs in NEJM, which are exercises in diagnosis in real patients writ large and found that a correct diagnosis was made in all CPCs despite complexity of patients discussed. Interestingly, a probabilistic approach was not employed for diagnosis in any CPC. The method employed consisted of construction of an exhaustive differential diagnosis followed by evaluation of each disease in it by how well it explained findings in patient (likelihood inference approach).

These CPCs have several important lessons for us, I suggest, regarding diagnosis in daily practice:


(a)    They call into question the relevance of a probabilistic approach which has been prescribed for diagnosis for a long time.

(b)   The method of exhaustive differential diagnosis and evaluation of each disease in it by its ability to explain patient findings appears to sidestep most or all cognitive biases which have been observed in diagnosis in daily practice.

(c)    Adoption of this method may improve diagnostic accuracy in daily practice which approaches the accuracy in these CPCs.

Regards

Bimal

Bimal  P Jain MD
Pulmonary Critical Care
Northshore Medical Center
Lynn MA 01904

From: Mark Graber [mailto:mark.graber at IMPROVEDIAGNOSIS.ORG]
Sent: Thursday, January 07, 2016 10:00 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] Wrongology


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Our movement to reduce diagnostic error faces the reality that these errors are not only common, some or perhaps many are inevitable given the complexity of the diagnostic process and the limits and foibles of our own cognition.  We seem to be ‘hard wired’ to commit the cognitive mistakes that underlie some diagnostic errors. Perhaps the largest challenge we face is the question of whether we can actually improve cognition to avoid these errors.

I’m sure everyone who follows our listserv is familiar with Pat Croskerry’s ongoing contributions to this debate through his work on debiasing.  I would like to call to attention several other great reads on this question.  My personal favorite is the bible for the ‘wrongology’ movement, Kathryn Schulz’s book “Being Wrong”.   If you don’t have time to read the book, watch her TED talk.

The attached review from the Times discusses two very recent books on this debate, and the review itself is a treat in summarizing the interaction between Daniel Kahneman, who is pessimistic about the possibility of ‘debiasing’, and Steven Pinker, a strong proponent of our capacity to overcome our cognitive biases.

Mark L Graber MD FACP
President, SIDM


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