Cognitive Error

  • Faculty development for academic medicine: what’s best?

    By Marjorie Stiegler on April 26, 2016
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    Are we (the establishment of academic medicine) doing a good job of providing mentorship to the next generation? What is the “path” or “formula” – is there one? Can we improve faculty development for those who have dedicated their professional careers to academic pursuits - those who will make the big discoveries and leaps forward in patient safety and quality healthcare? If you are an academic, I hope you'll...
  • Have You Ever “Almost Won” The Lottery?

    By Marjorie Stiegler on January 12, 2016
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    Did you buy a Powerball Lottery ticket? With a jackpot of 1.4 billion dollars for tomorrow’s Powerball Lottery drawing, record numbers of people are frenetically purchasing record numbers of tickets. For some, it is mere entertainment – an insignificant amount of income spent on an intangible pleasure, not much different from reading a novel. For others, it represents a bad investment and a completely irrational allocation of much-needed money. Evolution is not helping us. Here are a few of the hard-wired cognitive tendencies that keep the lottery alive and well:
  • Why Can’t We Fix the Diagnostic Error Epidemic?

    By Marjorie Stiegler on March 9, 2015
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    It is estimated that the volume of knowledge is doubling at least every 8 years. This rate of expansion overwhelms our capacity to stay abreast of emerging knowledge, even in the ever-narrowing micro-specialization of medical practice. New careers are created while other fields die out. Rapid access and effective delivery of information becomes paramount to both patient safety and professional success. It is not surprising, then, that the potential for delayed or incorrect diagnosis exists. Cognitive psychology theory also tells us it is not surprising that modern decision support systems are ineffective are reducing this problem. Why?
  • Never Be Wrong (Or At Least, Catch Yourself Sooner!)

    By Marjorie Stiegler on November 15, 2014
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    My last post discussed how the building blocks of expertise and experience - stored memory collections of events and ideas - are the repository from which we make diagnostic and therapeutic decisions. Now, let’s consider three key strategies that may assist us in counterbalancing availability bias (confusing memorability with probability). This post is intended to address cases in which expert intuition lead us to a cognitive error called “premature closure” – selecting the first plausible diagnosis that comes to mind and seems to match the contextual information. Strategies to prevent premature closure hinge upon...
  • When Patients Die, Blame and Shame is Still the Game

    By Marjorie Stiegler on April 1, 2014
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    With the leisure of hindsight, it is easy to tear apart case reports, and identify the single most glaring mistake that is simply responsible for the poor outcome.  However, one undeniable truth in safety culture and human error is that “try harder” or “don’t make mistakes” or “be more vigilant” are ineffective safeguards and ring hollow.  Here, I had the […]
  • Food for Thought

    By Marjorie Stiegler on January 1, 2014
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    Wise words by Dr. Stephen Covey. We see everything through our own personal lenses, complete with bias, preference, and past experiences that shape our current frames.
  • Nonrational Cognitive Processes in Medical Decision Making

    By Marjorie Stiegler on November 22, 2013
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    What are the processes that contribute to errors in medical decision making?  Certainly, medical decision making is complex,  and simple knowledge gaps could be to blame.  But very often, experienced physicians make medical decision errors in the form of cognitive errors.  Cognitive errors are thought process mistakes  frequently rooted in nonrational decision processes, rather than knowledge gaps.  What is a […]
  • Dual Process Reasoning and Diagnostic Error in Medicine

    By Marjorie Stiegler on September 26, 2013
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    What is dual process reasoning? How does dual process reasoning lead to diagnostic error in medicine? These are important patient safety questions. A recent review* by Dr. Pat Croskerry and colleagues seeks to answer those questions, and some excerpts of his work are presented below. Dual Process Reasoning Defined Type 1 refers to an intuitive model of thinking, if it […]
  • Cognitive Errors in Anesthesiology and Medicine

    By Marjorie Stiegler on June 13, 2013
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    Cognitive errors in anesthesiology, as in other medical specialties, are rooted in the low-visibility, elusive cognitive landscape of hardwired thinking processes.  Various forms of bias, heuristics, non-rational thought preferences, and other factors contribute to cognitive errors in anesthesiology.   Today, at the Carolina Refresher Course in Asheville, I gave a talk entitled “Psychology of Decision Making: Cognitive Errors in Anesthesiology” […]
  • Will Algorithms Replace Doctors? Not So Elementary, Watson.

    By Marjorie Stiegler on May 6, 2013
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    Are doctors necessary? Just how far might the automation of medicine go? These are questions posed by Jonathon Cohn in his article “The Robot Will See You Now” recently published in the Atlantic magazine and online. The article is about the computer Watson – yep, the same one set a record playing Jeopardy and earned the first $1,000,000 in winnings. […]
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