Diagnostic errors and reflective practice in medicine

Innovare Institute, Fortaleza, Ceará, Brazil.
Journal of Evaluation in Clinical Practice (Impact Factor: 1.58). 03/2007; 13(1):138-45. DOI: 10.1111/j.1365-2753.2006.00638.x
Source: PubMed

ABSTRACT 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.

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    • "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. "
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