Dual processing and diagnostic errors

Abstract

In this paper, I review evidence from two theories in psychology relevant to diagnosis and diagnostic errors. "Dual Process" theories of thinking, frequently mentioned with respect to diagnostic error, propose that categorization decisions can be made with either a fast, unconscious, contextual process called System 1 or a slow, analytical, conscious, and conceptual process, called System 2. Exemplar theories of categorization propose that many category decisions in everyday life are made by unconscious matching to a particular example in memory, and these remain available and retrievable individually. I then review studies of clinical reasoning based on these theories, and show that the two processes are equally effective; System 1, despite its reliance in idiosyncratic, individual experience, is no more prone to cognitive bias or diagnostic error than System 2. Further, I review evidence that instructions directed at encouraging the clinician to explicitly use both strategies can lead to consistent reduction in error rates.

Staying Out of Trouble

“…More importantly, when used together they are more effective than when used alone [17]. Diagnostic radiology is as pure a pattern recognition task as exists in medicine.…”

Improving Diagnostic Reasoning to Improve Patient Safety

“…However, abundant research suggests that both the intuitive and the analytic systems are critical, are interwoven, and have strengths and weaknesses. 12,13 A modern characterization of expert clinical judgment is the adroit recognition of the limits of intuition and acknowledging when analytic reasoning is required (ie, "knowing when to slow down"). 14 Diagnostic experts develop a base of experience and knowledge that increasingly employs intuitive reasoning to accurately diagnose the cases they confront, but they also develop an accurate sense of when analytic reasoning is merited.…”

Klinisch redeneren in het fysiotherapie onderwijs

“…1 Onderzoek naar klinisch redeneren is vooral uitgevoerd in het domein van de geneeskunde. [2][3][4][5] .Daaruit blijkt dat er in het diagnostisch en therapeutisch proces een relatie bestaat tussen het vermogen tot klinisch redeneren en het nemen van de juiste beslissingen. 6 Binnen het domein van de fysiotherapie is nog weinig onderzoek verricht naar klinisch redeneren.…”

“…Items identifi catie * Flexibiliteit in het denkproces (21 items): 4,5,11,15,16,24,28,30,32,35 Gespiegelde items : 2, 3, 6, 23, 26, 27, 34, 36, 38, 40, 41 * Kennisstructuur (20 items) : 1, 2, 8, 9, 12, 20, 31, 39 Gespiegelde items: 10,13,14,17,18,19,21,22,25,29,33,37 Onderzoek lation' methode omdat een eerder vertaalde versie van Beulens et al 23 …”