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Diagnostic Error  How EP Doctor Thinks Dr.Idris Al Farsi Senior Consultant Adult Emergency Department – Royal Hospital
Outlines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object]
Why thinking is important? ,[object Object]
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Diagnostic Error ,[object Object],[object Object],[object Object],[object Object],[object Object]
Why is the ED especially error-prone? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
black box approach ,[object Object]
Error-Producing Conditions in the ED  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Error-Producing Conditions  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
So it is important ,[object Object],[object Object],[object Object]
What is the significance of the high cognitive load?
Urgency of Decision Making ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Approaches to Decision Making
"cookbook" approach ,[object Object],[object Object],[object Object]
 
Intuitive Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Analytic Approach ,[object Object],[object Object],[object Object],[object Object]
Clustering of approaches on an intuitive-analytical continuum at unconscious
 
Dual process theory  approach to decision making ,[object Object],[object Object],[object Object]
" dual - process thinking ."
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic failure ,[object Object]
Firstly, the pattern associated with the initial presentation might be misidentified ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
" dual - process thinking ."
[object Object],[object Object],[object Object],[object Object]
Fourthly, there are many instances in which Type 1 processes override Type 2 reasoning in medical practice ,[object Object],[object Object],[object Object]
How can dual process models mitigate diagnostic error? ,[object Object],[object Object]
 
 
 
Practical Suggestions to Improve the Way That EPs Think ,[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Diagnostic error

Notas del editor

  1. Model for diagnostic reasoning based on pattern recognition and dual-process theory. The model is linear, running from left to right. The initial presentation of illness is either recognized or not by the observer. If it is recognized, the parallel fast, automatic processes of System 1 engage, whereas if it is not, the slower, analytical processes of System 2 engage instead. Determinants of System 1 and 2 processes are shown in dotted line boxes. Repetitive processing in System 2 leads to recognition and default to System 1 processing. Either system may override the other. A System 1 response may proceed directly to a diagnosis, or the outputs from both systems pass into a calibrator where interaction occurs to produce the ?nal diagnosis. A ‘cognitive miser’ function prevails—the tendency to default to a state that consumes fewer cognitive resources. Adapted with permission from Croskerry (2009a)
  2. Model for diagnostic reasoning based on pattern recognition and dual-process theory. The model is linear, running from left to right. The initial presentation of illness is either recognized or not by the observer. If it is recognized, the parallel fast, automatic processes of System 1 engage, whereas if it is not, the slower, analytical processes of System 2 engage instead. Determinants of System 1 and 2 processes are shown in dotted line boxes. Repetitive processing in System 2 leads to recognition and default to System 1 processing. Either system may override the other. A System 1 response may proceed directly to a diagnosis, or the outputs from both systems pass into a calibrator where interaction occurs to produce the ?nal diagnosis. A ‘cognitive miser’ function prevails—the tendency to default to a state that consumes fewer cognitive resources. Adapted with permission from Croskerry (2009a)