Diagnostic error, overconfidence and self-knowledge

Cassam, Quassim

doi:10.1057/palcomms.2017.25

Cited by 39 publications

(35 citation statements)

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“…Cassam considers this expectation that "self-knowledge is a remedy for physician overconfidence and the diagnostic errors to which it gives rise" (Borrell-Carrió and Epstein, 2004;Croskerry et al, 2013). But he tells us that this suggestion is "underestimating the obstacles to self-knowledge while overestimating its benefits" (Cassam, 2017). And in the course of the paper in this volume, he cites empirical evidence that shows that even after being shown and accepting that they are not as accurate as they take themselves to be in general, the subjects might go on to be as confident as they were before about the accuracy of their future judgments (Kahneman and Tversky, 1996, p 588).…”

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“…Our overconfident physician, even after concluding "I am overconfident", would probably go on to be as confident as she was before. Cassam concludes "Self-knowledge does not automatically lead to self-improvement" (Cassam, 2017). This implies that substantial knowledge of one's own stealthy epistemic vices does not satisfy the value condition automatically.…”

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“…Let us look more closely at how a physician's knowledge of her own overconfidence, of her "tendency to believe that she knows more than she does," (Cassam, 2017) satisfies the obstacle condition. What is in the way of acquisition of the knowledge of one's own overconfidence?…”

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“…First of all, she has an epistemicly vicious character trait. Overconfidence is a character trait which impedes the acquisition, retention and transfer of knowledge (Cassam, 2017). Having this character trait, the physician must be less than perfectly rational at least in matters require selfevaluation.…”

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“…In this paper, I will critically examine a case of substantial selfknowledge Cassam himself discusses in this collection (Cassam, 2017), namely the knowledge of one's own overconfidence. Cassam's analysis of overconfidence shows that substantial selfknowledge by itself does not bring about substantial self-change.…”

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Overconfidence, self-knowledge, and self-improvement

Özaltun

2017

Palgrave Commun

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Recently physician overconfidence has been considered as a major factor contributing to diagnostic error. A philosophical inquiry into overconfidence as a character vice has the promise of shedding light on how we can overcome this vice and potentially reduce diagnostic errors. In his recent work, Quassim Cassam conducts such an inquiry. This paper puts Cassam’s work on physician overconfidence in the context of his theoretical work on self-knowledge and epistemic vices. It shows that physician overconfidence, considered as a major factor in diagnostic error, provides a significant real-life application of Cassam’s accounts of self-knowledge and epistemic vices. It focuses on the features of these accounts that lead to the following result: self-knowledge is rarely, if ever, a remedy for physicians’ overconfidence and the resulting diagnostic errors. By appealing to the same data Cassam cites regarding diagnostic error and physicians’ overconfidence, it is shown that the more substantial—in the sense Cassam specifies—one’s third-personal knowledge of oneself is, the less likely it is to be of any practical value qua self-knowledge. This paper defends the view that what Cassam calls ‘trivial self-knowledge’—first-personal knowledge that has been the primary concern for philosophers—is crucial for any kind of self-knowledge to be instrumental for self-improvement. Since an agent acts from the standpoint that she is aware of herself trivially, it is argued that what Cassam calls ‘substantial self-knowledge’ has no practical value unless it is integrated with what he calls ‘trivial self-knowledge’. In this way the paper explains why if what one learns about oneself from the third-person perspective is drastically different from what one takes to be true from the first-person perspective, one cannot act on this knowledge. Since the standpoint from which one experiences and acts intentionally are one and the same, the paper also explains why traumatic experiences (such as the death of a patient or of a loved one) can sometimes lead to fundamental change and self-improvement.

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Overconfidence, self-knowledge, and self-improvement

Özaltun

2017

Palgrave Commun

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Bias

Moseley¹

2019

The International Encyclopedia of Ethics

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The term “bias” in its pejorative sense commonly refers to racism or other forms of prejudice. In this entry “bias” is used in a more restrictive sense to refer to systematic errors. The entry is divided into four sections. First, given the central role of error in this understanding of bias, it is helpful to consider what it is to err and to distinguish different kinds of error. Two main kinds of errors are identified: errors of thought and errors of action. Errors of thought include cognitive, perceptual, and affective errors. Errors of action are errors involved in bringing about one's ends of action. The entry examines ethical issues that pertain to the relation of these types of error, distinguishes error and ignorance, and explains their moral significance. Third, a framework for explaining forms of bias is provided, distinguishing four levels of explanation: personal, subpersonal, situational, and systemic. Finally, ethical complexities in attributing bias are examined.

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Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

et al. 2020

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Background: The accuracy with which surgeons can predict outcomes following surgery has not been explored in a systematic way. The aim of this review was to determine how accurately a surgeon's 'gut feeling' or perception of risk correlates with patient outcomes and available risk scoring systems.Methods: A systematic review was undertaken in accordance with PRISMA guidelines. A narrative synthesis was performed in accordance with the Guidance on the Conduct of Narrative Synthesis In Systematic Reviews. Studies comparing surgeons' preoperative or postoperative assessment of patient outcomes were included. Studies that made comparisons with risk scoring tools were also included. Outcomes evaluated were postoperative mortality, general and operation-specific morbidity and long-term outcomes.Results: Twenty-seven studies comprising 20 898 patients undergoing general, gastrointestinal, cardiothoracic, orthopaedic, vascular, urology, endocrine and neurosurgical operations were included. Surgeons consistently overpredicted mortality rates and were outperformed by existing risk scoring tools in six of seven studies comparing area under receiver operating characteristic (ROC) curves (AUC).Surgeons' prediction of general morbidity was good, and was equivalent to, or better than, pre-existing risk prediction models. Long-term outcomes were poorly predicted by surgeons, with AUC values ranging from 0⋅51 to 0⋅75. Four of five studies found postoperative risk estimates to be more accurate than those made before surgery.Conclusion: Surgeons consistently overestimate mortality risk and are outperformed by pre-existing tools; prediction of longer-term outcomes is also poor. Surgeons should consider the use of risk prediction tools when available to inform clinical decision-making.

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Diagnostic error, overconfidence and self-knowledge

Cited by 39 publications

References 33 publications

Overconfidence, self-knowledge, and self-improvement

Overconfidence, self-knowledge, and self-improvement

Bias

Systematic review and narrative synthesis of surgeons' perception of postoperative outcomes and risk

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