Module 2: Clinical Problem Solving Flashcards
1
Q
conditions that promote diagnostic errors
A
- uncertainty everywhere
- novel situations
- high decisions density
- handoff problems
- time constraints
- workload stress
- low signal to noise ratio
- high cognitive load
- shift work factors
- constant interruptions
- physical & emotional stress
2
Q
cognitive error categories
A
- technical errors
- faulty knowledge
- faulty data gathering
- faulty information processing
- faulty verification
- unchecked biases
3
Q
anchoring bias?
A
- focus on 1st piece of info aka premature closure
- is the most common diagnostic error
- fail to continue considering reasonable alternatives after initial (working) dx is reached
4
Q
availability bias?
A
- reliance on things that might immediately come to mind
- tendency to judge things as being more likely if they readily come to mind
5
Q
confirmation bias?
A
- looking only for evidence that confirms/supports diagnosis
- don’t look for disconfirming evidence to refute initial diagnosis
- ignore evidence that contradicts diagnosis
6
Q
unpacking principle
A
- Keep it simple silly
- failure to elicit all relevant information before a differential diagnosis is established
- result in significant possibilities being missed
7
Q
overconfidence?
A
- tendency to believe we know more than we do
- tend to act on incomplete info, intuition or hunch
- too much faith placed on initial impression, rather than carefully collected data
8
Q
diagnostic momentum?
A
- chart lore or copy forward
- once a diagnostic label is attached to a condition it’s hard to remove it
- tendency to not to want to override it
9
Q
visceral ‘attribution bias’
A
- stereotypes
- negative feelings towards a patient may result in diagnoses being missed
- common types: non-compliant patients, homeless, patients with chronic pain especially those requesting an opioid, obese patients, patients with alcohol on their breath, patients of different background
10
Q
satisfaction of search?
A
you’re tired, under pressure, it’s hard to think of other diagnoses
- you find one answer that explains all of the data, your’e satisfied and stop examining alternatives
- Ockham’s razor - the simplest explanation is usually the correct one
11
Q
how to proceed?
A
select working diagnosis and proceed with plan, remember to follow up with others on differential, be open to change
12
Q
requirements for diagnostic accuracy & efficiency
A
- depth of medical knowledge
- complete yet concise case representation
- identification of salient features
- make diagnosis
13
Q
fast thinking processes for diagnosing?
A
- intuitive - passive - unconscious, instinctual
- pattern recognition
- contextual
- based on prior experience (exposures)
- options considered are limited
- high risk of error (atypical presentation, missing cardinal symptom)
14
Q
slow thinking processes for diagnosing
A
- deliberative - active, stepwise
- analysis of data available
- logical, rule based
- based on critical thinking
- larger number of options considered
- low risk of error
15
Q
heuristic cognitive style?
A
intuitive
