Donald A. Redelmeier, MD
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, email@example.com.
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.
Redelmeier DA. The Cognitive Psychology of Missed Diagnoses. Ann Intern Med. 2005;142:115–120. doi: 10.7326/0003-4819-142-2-200501180-00010
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Published: Ann Intern Med. 2005;142(2):115-120.
Cardiac Diagnosis and Imaging, Cardiology, Education and Training, Emergency Medicine, Endocarditis.
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