Clinical Reasoning Cycle & CRC Errors

Question 1

Clinical reasoning cycle steps

Answer 1

1. Consider the patient
   - their context, situation, how this influences health
2. Collect cues
   - Review information, Gather new information, Recall relevant info
3. Process information
   - interpret normal/abnormal, discriminate relevant/irrelevant, relate to determine relationships and patters, match to past situations, predict an outcome
4. Identify problems
5. Establish goals
   - synthesise the facts and the knowledge
6. Take action
   - describe what you want to happen
7. Evaluate
8. Reflect
   - what could have been done differently or better

Question 2

Clinical reasoning cycle errors

Answer 2

1. Anchoring
2. Ascertainment bias
3. Confirmation bias
4. Diagnostic momentum
5. Fundamental attribution error
6. Over-confidence bias
7. Premature closure
8. Psych-out error
9. Unpacking principal

Question 3

Anchoring

Answer 3

Tendency to lock onto salient feature of presentation and let that blind you to other pertinent presentation features
Eg. Mn just cam out of surgery in pain, keep checking wound to see f that’s causing pain when really its a bent catheter,

Question 4

Ascertainment bias

Answer 4

When thinking is shaped by stereotyping, assumptions and preconceptions
Eg. Old patient not recovering from infection, nurse assumes they are forgetting to take the medication not just not responding to it

Question 5

Confirmation bias

Answer 5

Tendency to look for evidence which confirms rather than refutes your diagnosis even though the latter is more accurate
Eg. In the case of the bent catheter if the patient were clutching around the area of the wound in pain

Question 6

Diagnostic momentum

Answer 6

When several cues align to point to one outcome and the diagnosis is made in a flurry without fully considering other options

Question 7

Fundamental attribution error

Answer 7

Tendency to blame individuals for their condition over looking for other causes
Eg. Overweight may think poor diet when really have thyroid issues

Question 8

Over-confidence bias

Answer 8

Tendency to think we’re right before we have sufficient evidence.
Eg. Seen certain cardiac rhythm a million times before, know its going to be safe when really it isn’t

Question 9

Premature closure

Answer 9

Coming to a diagnosis and conclusion before all cues have been detected and diagnosis verified.
Eg. The catheter example

Question 10

Psych-out error

Answer 10

With psychiatric patients its easy to be blind to co-morbidities and attribute all conditions to their mental illness

Question 11

Unpacking principle

Answer 11

Failure to collect all relevant cue in establishing a diagnosis, significant possibilities may be missed