Adverse effects of medical errors have received increasing attention. Diagnostic errors account for a substantial fraction of all medical errors, and strategies for their prevention have been explored. A crucial requirement for that is better understanding of origins of medical errors. Research on medical expertise may contribute to that as far as it explains reasoning processes involved in clinical judgements. The literature has indicated the capability of critically reflecting upon one's own practice as a key requirement for developing and maintaining medical expertise throughout life.
This article explores potential relationships between reflective practice and diagnostic errors.
A survey of the medical expertise literature was conducted. Origins of medical errors frequently reported in the literature were explored. The potential relationship between diagnostic errors and the several dimensions of reflective practice in medicine, brought to light by recent research, were theoretically explored.
Uncertainty and fallibility inherent to clinical judgements are discussed. Stages in the diagnostic reasoning process where errors could occur and their potential sources are highlighted, including the role of medical heuristics and biases. The authors discuss the nature of reflective practice in medicine, and explore whether and how the several behaviours and reasoning processes that constitute reflective practice could minimize diagnostic errors. Future directions for further research are discussed. They involve empirical research on the role of reflective practice in improving clinical reasoning and the development of educational strategies to enhancing reflective practice.
"Children in this category are vulnerable since they outwardly appear withdrawn in-their-own-world, solitary and/or left-out; more so, owing to peer rejection rather than their reluctance to get closer to them as with cases of autism. A fine distinction is needed between the rejected and the rejecting child-which is often missed during routine diagnostic search exercises (Mamede et al. 2007). Other look-alike diagnostic conditions like "
[Show abstract][Hide abstract] ABSTRACT: There is a growing trend in favor of diagnosing many children as cases of autism. This study seeks to address the key problems and issues related to diagnosis of children as autism in our country. One-hundred fifty four cases of children below 8 years diagnosed as autism at some point in their lifetime underwent a detailed individualized re-evaluation covering manifold processes and techniques. Data units of information attempted to recapture the subjective experience of diagnostic decision making by using schemas that enables one ‘to think about it, mull it over and evaluate it’. Results analyzed in terms of derived quantitative and qualitative metrics highlight more than 60 sources of diagnostic errors. Thus, out of the studied sample only 30 children (19.48 %) eventually qualified for final diagnosis of autism against the set official criteria. The findings are delineated with explanations and examples for prospective diagnosticians to be wary before labeling children as autism or on its spectrum.
"Clinical reasoning results from the interpretation of data by a specific clinician faced with a specific situation (a specific patient within a specific context presenting with a specific constellation of signs and symptoms). The clinician brings to each encounter his/her own knowledge, skills, beliefs, and perspectives which influence his/her perception and interpretation of data (Mamede et al. 2007). The result of clinical reasoning is not necessarily a precise diagnosis. "
[Show abstract][Hide abstract] ABSTRACT: Background: Clinical reasoning is the cornerstone of medical practice. To date, there is no established framework regarding clinical reasoning difficulties, how to identify them, and how to remediate them. Aim: To identify the most common clinical reasoning difficulties as they present in residents' patient encounters, case summaries, or medical notes. To develop a guide to support medical educators' process of educational diagnosis and management in this area. Methods: We used a participatory action research method. We carried out eight iterative reflective cycles with a group of clinical teachers. The repeated phases of experimentation and observation were conducted by participants in their own clinical teaching setting. Our findings were tested and validated on both an individual and collective basis Results: We found five categories of clinical reasoning difficulties as they present in the clinical teaching settings. We identified indicators for each. Indicators may be different depending on the type of supervision. These findings were assembled and organized to construct a guide for clinical teachers. Conclusions: The guide should assist clinical teachers in detecting clinical reasoning difficulties during clinical teaching and in providing remediation that is tailored to the specific difficulty identified. Its development furthers our understanding of clinical reasoning difficulties and provides a useful tool.
Medical Teacher 12/2012; 35(3). DOI:10.3109/0142159X.2012.733041 · 1.68 Impact Factor
"A variety of debiasing strategies in making diagnoses have been introduced such as metacognition, cognitive forcing strategies, reflection, enforcing analytical reasoning, feedback, electronic systems, and checklists.13,14,22,23,29,39–49 In this article, we introduce a new, practical, and quick-impact error-reducing strategy. "
[Show abstract][Hide abstract] ABSTRACT: Diagnostic errors constitute a substantial portion of preventable medical errors. The accumulation of evidence shows that most errors result from one or more cognitive biases and a variety of debiasing strategies have been introduced. In this article, we introduce a new diagnostic strategy, the pivot and cluster strategy (PCS), encompassing both of the two mental processes in making diagnosis referred to as the intuitive process (System 1) and analytical process (System 2) in one strategy. With PCS, physicians can recall a set of most likely differential diagnoses (System 2) of an initial diagnosis made by the physicians' intuitive process (System 1), thereby enabling physicians to double check their diagnosis with two consecutive diagnostic processes. PCS is expected to reduce cognitive errors and enhance their diagnostic accuracy and validity, thereby realizing better patient outcomes and cost- and time-effective health care management.
International Journal of General Medicine 11/2012; 5:917-21. DOI:10.2147/IJGM.S38805
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