Article    Table of Contents                    Full Text of this article Free    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Published comments/rapid response letters    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Redelmeier, D. A.    Related Articles in PubMed    PubMed Citation    PubMed

IMPROVING PATIENT CARE

QUALITY GRAND ROUNDS

Series Editors: Robert M. Wachter, MD; Kaveh G. Shojania, MD; Sanjay Saint, MD, MPH; Amy J. Markowitz, JD; and Mark Smith, MD, MBA

Improving Patient Care is a special section within Annals supported in part by the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this article are those of the authors and do not represent the position or endorsement of AHRQ or HHS.

Funding for the Quality Grand Rounds series is supported by the California Health Care Foundation as part of its Quality Initiative. The authors are supported by general institutional funds.

The Cognitive Psychology of Missed Diagnoses

Donald A. Redelmeier, MD

18 January 2005 | Volume 142 Issue 2 | Pages 115-120

Cognitive psychology is the science that examines how people reason, formulate judgments, and make decisions. This case involves a patient given a diagnosis of pharyngitis, whose ultimate diagnosis of osteomyelitis was missed through a series of cognitive shortcuts. These errors include the availability heuristic (in which people judge likelihood by how easily examples spring to mind), the anchoring heuristic (in which people stick with initial impressions), framing effects (in which people make different decisions depending on how information is presented), blind obedience (in which people stop thinking when confronted with authority), and premature closure (in which several alternatives are not pursued). Rather than trying to completely eliminate cognitive shortcuts (which often serve clinicians well), becoming aware of common errors might lead to sustained improvement in patient care.

Author and Article Information

From the University of Toronto, Institute for Clinical Evaluative Sciences, and Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.

Acknowledgments: The author thanks Tracy Willson for administration support, and Chris Denny, MD, MSc; Edward Etchells, MD, MSc; Damon Scales, MD; Steven Shumak, MD; and Matthew Stanbrook, MD, PhD, for commenting on drafts of this manuscript.

Grant Support: By the Canada Research Chair in Medical Decision Sciences, Error Management Unit of Sunnybrook and Women's College Health Sciences Centre, and Canadian Institute for Health Research. These funding sources had no role in the design, conduct, or reporting of this project. Funding for the Quality Grand Rounds series is supported by the California HealthCare Foundation as part of its Quality Initiative. The authors are supported by general institutional funds.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Donald A. Redelmeier, MD, Sunnybrook and Women's College Health Sciences Centre, Room G-151, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada; e-mail, dar{at}ices.on.ca.

Related articles in Annals:

Letters
Cognitive Psychology of Missed Diagnoses
David D. Derauf

Annals 2005 142: 1026. [Full Text]  

Letters
Cognitive Psychology of Missed Diagnoses
Donald A. Redelmeier

Annals 2005 142: 1026. [Full Text]  

Letters
Graduate Medical Education and Patient Safety
Matthew N. Fine

Annals 2007 146: 685. [Full Text]  

This article has been cited by other articles:

				R. Saad, A. T. Yamada, F. H. F. Pereira da Rosa, P. S. Gutierrez, and A. J. Mansur Comparison between clinical and autopsy diagnoses in a cardiology hospital Heart, November 1, 2007; 93(11): 1414 - 1419. [Abstract] [Full Text] [PDF]

				D. K Sokol Can deceiving patients be morally acceptable? BMJ, May 12, 2007; 334(7601): 984 - 986. [Full Text] [PDF]

				M. N. Fine Graduate Medical Education and Patient Safety Ann Intern Med, May 1, 2007; 146(9): 685 - 685. [Full Text] [PDF]

				P. D. Levy, R. L. Sherwin, G. J. Kuhn, G. J. McColl, M. A. Groves, M. R. Echols, K. S. Garman, K. W. Lyles, E. Marsh, A. Sorisky, et al. Clinical Diagnostic Reasoning N. Engl. J. Med., March 22, 2007; 356(12): 1272 - 1274. [Full Text] [PDF]

				H. Ammar, A. K. Malani, C. Gupta, and D. C. Dobyan Brain Natriuretic Peptide, Clinical Reasoning, and Congestive Heart Failure Am. J. Crit. Care., November 1, 2006; 15(6): 614 - 616. [Full Text] [PDF]

				D. B. Nash Hospital-Acquired Infections: Raising the Anchoring Heuristic American Journal of Medical Quality, November 1, 2006; 21(6_suppl): 5S - 6S. [PDF]

				K. G. Shojania, K. E. Fletcher, and S. Saint Graduate medical education and patient safety: a busy--and occasionally hazardous--intersection. Ann Intern Med, October 17, 2006; 145(8): 592 - 598. [Abstract] [Full Text] [PDF]

				R. M. Wachter, K. G. Shojania, A. J. Markowitz, M. Smith, and S. Saint Quality grand rounds: the case for patient safety. Ann Intern Med, October 17, 2006; 145(8): 629 - 630. [Full Text] [PDF]

				H Singh, L A Petersen, and E J Thomas Understanding diagnostic errors in medicine: a lesson from aviation. Qual. Saf. Health Care, June 1, 2006; 15(3): 159 - 164. [Abstract] [Full Text] [PDF]

				D. D. Derauf Cognitive Psychology of Missed Diagnoses Ann Intern Med, June 21, 2005; 142(12_Part_1): 1026 - 1026. [Full Text] [PDF]

Rapid Responses: