Diagnostic errors and reflective practice in medicine

ArticleinJournal of Evaluation in Clinical Practice 13(1):138-45 · March 2007with52 Reads
DOI: 10.1111/j.1365-2753.2006.00638.x · Source: PubMed
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.
    • "Therefore, ruling patients out because they do not seem technologically savvy could be misguided. While caution is needed to avoid painting heuristics as altogether bad, caution is also warranted against the potential errors in overreliance on snap judgments and pattern recognition as modes of reasoning , given their susceptibility to error (Mamede et al, 2007; Norman and Eva, 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Innovations in hearing aid technology influence clinicians and individuals who use hearing aids. Little research, to date, explains the innovation adoption experiences and perspectives of clinicians and patients, which matter to a field like audiology, wherein technology innovation is constant. By understanding clinician and patient experiences with such innovations, the field of audiology may develop technologies and ways of practicing in a manner more responsive to patients’ needs, and attentive to society’s influence. Purpose: The authors aimed to understand how new innovations influence clinician and patient experiences, through a study focusing on connected hearing aids. ‘‘Connected’’ refers to the wireless functional connection of hearing aids with everyday technologies like mobile phones and tablets. Research Design: The authors used a qualitative collective case study methodology, borrowing from constructivist grounded theory for data collection and analysis methods. Specifically, the authors designed a collective case study of a connected hearing aid and smartphone application, composed of two cases of experience with the innovation: the case of clinician experiences, and the case of patient experiences. Study Sample: The qualitative sampling methods employed were case sampling, purposive within-case sampling, and theoretical sampling, and culminated in a total collective case n = 19 (clinician case n = 8; patient case n = 11). These data were triangulated with a supplementary sample of ten documents: relevant news and popular media collected during the study time frame. Data Collection and Analysis: The authors conducted interviews with the patients and clinicians, and analyzed the interview and document data using the constant comparative method. The authors compared their two cases by looking at trends within, between, and across cases. Results: The clinician case highlighted clinicians’ heuristic based candidacy judgments in response to the adoption of the connected hearing aids into their practice. The patient case revealed patients’ perceptions of themselves as technologically competent or incompetent, and descriptions of how they learned to use the new technology. Between cases, the study found a difference in the response to how the connected hearing aid changed the clinician–patient relationship. While clinicians valued the increased time they spent getting to know their patients, patients experienced some frustration specific to the additional troubleshooting related to Bluetooth connectivity. Across cases, there was a resounding theme of "normalization" of hearing aids via their integration with a "normal" technology (mobile phones)and general lack of concern about privacy in relation to the smartphone application and its tracking and geotagging features. Both audiologists and patients credited the connected hearing aids with increased opportunities to participate more fully in everyday life. Conclusions: The introduction of smartphone-connected hearing aids influenced the identities and candidate profiles of hearing aid users, and the nature of time spent in clinical interactions, in important and interesting ways. The influence of connected hearing aids on patient experience and audiology practice calls for continued research and clinical consideration, with implications for clinical decision-making regarding hearing aid candidacy. Further study should look critically at normalization and possible unintended stigmatizing effects of making hearing aids increasingly discreet.
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    • "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 "
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    Article · Jun 2015
    • "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 Author's personal copy mental retardation need clinical acumen to differentiate specific and globalized early developmental delays, discover intra-test scatter despite apparent or outward behavioral similarities like limited speech-vocabulary, sensory issues, problems in communicating with peers, learning difficulties, absence of pretend play, repetitive behavior or stimming for self stimulation (hand flapping or body rocking), etc. "
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