Diagnostic error - cause or outcome, event or process

Elias Peter pheski69 at GMAIL.COM
Wed Apr 12 00:42:41 UTC 2017

Excellent and useful feedback.

Here’s a follow-up question. If I were working with a training program (say, a family practice residency) and wanted to help them understand rationality and avoid the commonest sources of cognitive misfire (I hate the word failure), can you identify a handful of references or resources that they might find useful?

Peter Elias

> On 2017.04.11, at 8:10 PM, Pat Croskerry <croskerry at eastlink.ca> wrote:
> Thanks Peter and for your earlier contributions to this discussion.
> Bob Latino’s blog raises a number of important issues.
> The para towards the end that begins: When talking to the decision maker… gives a good feel for the complexity of the diagnostic process, especially if one is attempting a cognitive RCA.
> Individual factors that influence decision making are multifarious and Bob mentions some of the main ones – others are age, gender, and personality of the decision maker.
> Cognition is invisible for the most part, and inferences are vulnerable to hindsight and outcome bias.
> However, I don’t think the problem is insurmountable.
> The cognitive scientists have been busy for the last few years on how we make decisions.
> One of the major concepts to emerge has been the notion of individual rationality – largely missing from extant RCAs.
> In terms of decision making, rationality is now considered superlative to all else – it trumps critical thinking and intelligence.
> It is no longer seen as binomial i.e. that someone is either rational or not, but rather is distributed, just like intelligence – thus some folk will be more rational than others (this doesn’t necessarily mean smarter )
> Rationality can now be measured on appropriate tests – it is possible to calculate an RQ score (rationality quotient) – consider including it on medical school admissions?
> Importantly, we know the main sources of rationality failure – they are (a ) cognitive miserliness (tendencies to treat information superficially or with insufficient effort), (b) mindware gaps (missing bits of critical information, failures in probability reasoning etc),  and (c) mindware contamination – logical failures in reasoning, cognitive biases, eccentric reasoning.
> If people understood these three main sources of cognitive failure and how to recognise them, as well some of the other major factors that influence individual cognition, and were mindful of hindsight and outcome bias, a reasonable stab at a cognitive RCA might be possible.
> Pat Croskerry
> From: Elias Peter [mailto:pheski69 at GMAIL.COM] 
> Sent: April 11, 2017 9:34 AM
> Subject: [IMPROVEDX] Diagnostic error - cause or outcome, event or process
> Bob Latino wrote an interesting blog post about error here:
> https://www.linkedin.com/pulse/error-cause-outcome-bob-latino?published=t <https://www.linkedin.com/pulse/error-cause-outcome-bob-latino?published=t>
> (Disclaimer - he included a comment I provided as feedback when I read it.)
> I think it is very pertinent to the discussions this group has about the nature of diagnostic error, and I’d be interested in hearing what the group thinks. I’ll hold off on contributing my thoughts to avoid framing the conversation.
> Peter Elias, MD
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