Cognitive forcing strategies in clinical decisionmaking.

Full Abstract

Cognitive errors underlie most diagnostic errors that are made in the course of clinical decisionmaking in the emergency department. These errors are universal and are prevalent in the special milieu of the ED. Their properties appear to be distinct from those associated with the performance of procedures. They are often costly, but, importantly for both the patient and the physician, they are also highly preventable. Recent developments in education theory provide a means for minimizing and avoiding diagnostic error. Through the process of metacognition, clinicians can develop cognitive forcing strategies to abort such latent errors. Three levels of cognitive forcing strategies are described:
universal, generic, and specific. Specific cognitive forcing strategies provide a formal cognitive debiasing approach to deal with what have previously been described as pitfalls in clinical reasoning. This metacognitive approach can be taught to practicing clinicians and to those in training to inoculate them against making diagnostic errors. The adoption of this method provides a systematic approach to cognitive root-cause analysis in the avoidance of adverse outcomes associated with delayed or missed diagnoses and with the clinical management of specific cases.

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Author information

Author/s: Croskerry, Pat (P);

Affiliation: Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. sherri.lamont(-atsign-)cdha.nshealth.ca

Grants: P20HS11592-02 (Agency:AHRQ HHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.

Journal: Annals of emergency medicine (Ann Emerg Med), published in United States. (Language: eng)

Reference: 2003-Jan; vol 41 (issue 1) : pp 110-20

Dates: Created 2003/01/06; Completed 2003/01/24; Revised 2007/11/14;

PMID: 12514691, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Ann Emerg Med. 2003 Jan;41(1):121-2. (PMID: 12514692)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Decision Making
Diagnostic Errors - prevention & control
Humans
Mental Processes

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