Diagnosing, fast and slow

Postgrad Med J. 2021 Feb;97(1144):103-109. doi: 10.1136/postgradmedj-2019-137412. Epub 2020 Jun 28.

Abstract

Diagnostic error is increasingly recognised as a source of significant morbidity and mortality in medicine. In this article, we will attempt to address several questions relating to clinical decision making; How do we decide on a diagnosis? Why do we so often get it wrong? Can we improve our critical faculties?We begin by describing a clinical vignette in which a medical error occurred and resulted in an adverse outcome for a patient. This case leads us to the concepts of heuristic thinking and cognitive bias. We then discuss how this is relevant to our current clinical paradigm, examples of heuristic thinking and potential mechanisms to mitigate bias.The aim of this article is to increase awareness of the role that cognitive bias and heuristic thinking play in medical decision making. We hope to motivate clinicians to reflect on their own patterns of thinking with an overall aim of improving patient care.

Keywords: Cardiology; adult cardiology; coronary intervention; myocardial infarction; valvular heart disease.

Publication types

  • Review

MeSH terms

  • Bias
  • Clinical Decision-Making*
  • Diagnostic Errors / prevention & control*
  • Diagnostic Errors / statistics & numerical data*
  • Humans
  • Problem Solving
  • Thinking*
  • Uncertainty