19 May 2022

Diagnosing the problem

Mistakes in diagnosing patients can lead to tragic consequences, and to cut down the number of errors, it’s important to understand why they happen in the first place. A report by the Institute of Medicine (IOM) in 2015 listed 12 psychological reasons why doctors make diagnostic mistakes, including having an incomplete history, faulty perception and failing to recognise patterns.

But writing in Psychology Today, Dr Gary Klein, a senior scientist at MacroCognition LLC and author of Seeing What Others Don’t: The remarkable ways we gain insight, challenged the usefulness of those reasons. He argues they rely too much on hindsight to actually be helpful to medics.

One factor in the IOM report, “being captured by an initial mistaken diagnosis and failing to revise”, is highlighted as potentially important. But Dr Klein argues that even there, too much emphasis is placed on cognitive and confirmation bias. Instead, he claims that more attention should be given to the idea of fixation errors, where people focus on just one aspect of a situation.

The essay, co-written by Professor Rollin J Fairbanks, says: “If we can’t be clear about the causes of the diagnostic errors, we have little hope of reducing them.”

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