Information de reference pour ce titreAccession Number: | 00001888-200908000-00014.
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Author: | Croskerry, Pat MD, PhD
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Institution: | Dr. Croskerry is professor, Department of Emergency Medicine, Faculty of Medicine and Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada.
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Title: | |
Source: | Academic Medicine. 84(8):1022-1028, August 2009.
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Abstract: | Clinical judgment is a critical aspect of physician performance in medicine. It is essential in the formulation of a diagnosis and key to the effective and safe management of patients. Yet, the overall diagnostic error rate remains unacceptably high. In more than four decades of research, a variety of approaches have been taken, but a consensus approach toward diagnostic decision making has not emerged.
In the last 20 years, important gains have been made in psychological research on human judgment. Dual-process theory has emerged as the predominant approach, positing two systems of decision making, System 1 (heuristic, intuitive) and System 2 (systematic, analytical). The author proposes a schematic model that uses the theory to develop a universal approach toward clinical decision making. Properties of the model explain many of the observed characteristics of physicians' performance. Yet the author cautions that not all medical reasoning and decision making falls neatly into one or the other of the model's systems, even though they provide a basic framework incorporating the recognized diverse approaches. He also emphasizes the complexity of decision making in actual clinical situations and the urgent need for more research to help clinicians gain additional insight and understanding regarding their decision making.
(C) 2009 Association of American Medical Colleges
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References: | 1 Nuland SB. How We Die: Reflection on Life's Final Chapter. New York, NY: Alfred A. Knopf; 1994.
2 Gawande A. Final cut. In: Complications: A Surgeon's Notes on an Imperfect Science. New York, NY: Henry Holt and Company; 2002;197-198.
3 Graber M. Diagnostic errors in medicine: A case of neglect. Jt Comm J Qual Patient Saf. 2005;31:106-113.
4 Lundberg GD. Low-tech autopsies in the era of high-tech medicine: Continued value for quality assurance and patient safety. JAMA. 1998;280:1273-1274.
5 Barnett GO, Cimino JJ, Hupp JA, Hoffer EP. DXplain. An evolving diagnostic decision-support system. JAMA. 1987;258:67-74.
6 Warner HR Jr. Iliad: Moving medical decision-making into new frontiers. Methods Inf Med. 1989;28:370-372.
7 Miller RA, Masarie FE Jr. Use of the Quick Medical Reference (QMR) program as a tool for medical education. Methods Inf Med. 1989;28:340-345.
8 Ramnarayan P, Cronje N, Brown R, et al. Validation of a diagnostic reminder system in emergency medicine: A multi-centre study. Emerg Med J. 2007;24:619-624.
9 Bruner J. Actual Minds, Possible Worlds. Cambridge, Mass: Harvard University Press; 1987.
10 Hammond KR. Intuitive and analytic cognition: Information models. In: Sage A, ed. Concise Encyclopedia of Information Processing in Systems and Organizations. Oxford, UK: Pergamon Press; 1990;306-312.
11 Klein G. Sources of power. Cambridge, Mass: MIT Press; 1999.
12 Kahneman D, Slovic P, Tversky A. Judgment under uncertainty: Heuristics and biases. Cambridge, UK: Cambridge University Press; 1982.
13 Ambady N, Rosenthal R. Thin slices of behavior as predictors of interpersonal consequences: A meta-analysis. Psychol Bull. 1992;2:256-274.
14 Simon HA. Rational choice and the structure of the environment. Psychol Rev. 1956;63:129-138.
15 Cosmides L, Tooby J. Cognitive adaptations for social exchange. In: Barkow JH, Cosmides L, Tooby J, eds. The Adapted Mind: Evolutionary Psychology and the Generation of Culture. Oxford, UK: Oxford University Press; 1992:163-228.
16 Bargh JA, Chartrand TL. The unbearable automaticity of being. Am Psychol. 1999;54:462-479.
17 Dijksterhuis A, Bos MW, Nordgren LF, von Baaren RB. On making the right choice: The deliberation-without-attention-effect. Science. 2006;311:1005-1007.
18 Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical epidemiology: A basic science for clinical medicine. Boston, Mass: Little, Brown and Company; 1991.
19 Croskerry P. Shiftwork, fatigue, and safety in emergency medicine. In: Croskerry P, Cosby KS, Schenkel S, Wears R, eds. Patient Safety in Emergency Medicine. Philadelphia, Pa: Lippincott Williams & Wilkins; 2008.
20 Ullman DG. Making Robust Decisions: Decision Management for Technical, Business, and Service Teams. Victoria, BC: Trafford Publishing; 2006.
21 Hammond K. Human Judgment and Social Policy: Irreducible Uncertainty, Inevitable Error, Unavoidable Injustice. New York, NY: Oxford University Press; 2000.
22 Sloman S. The empirical case for two systems of reasoning. Psychol Bull. 1996;119:3-22.
23 Stanovich KE. The Robot's Rebellion: Finding Meaning in the Age of Darwin. Chicago, Ill: The University of Chicago Press; 2004.
24 Evans JS. Dual-processing accounts of reasoning, judgment, and social cognition. Annu Rev Psychol. 2008;59:255-278.
25 Brieger D, Eagle KA, Goodman SG, et al. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: Insights from the Global Registry of Acute Coronary Events. Chest. 2004;126:461-469.
26 Simpson T, Carruthers P, Laurence S, Stich S. Nativism past and present. In: Carruthers P, Laurence S, Stich S, eds. The Innate Mind. New York, NY: Oxford University Press; 2005.
27 Gilovich T, Griffin D, Kahneman D. Heuristics and biases: The psychology of Intuitive Judgment. New York, NY: Cambridge University Press; 2002.
28 Risen J, Gilovich T. Informal logical fallacies. In: Sternberg RJ, Roediger HL, Halpern DF, eds. Critical Thinking in Psychology. New York, NY: Cambridge University Press; 2007:110-130.
29 Regehr G, Norman GR. Issues in cognitive psychology: Implications for professional education. Acad Med. 1996;71:988-1001.
30 Schmidt HG, Norman GR, Boshuizen HP. A cognitive perspective on medical expertise: Theory and implication. Acad Med. 1990;65:611-621.
31 Klein GA, Orasanu J, Calderwood R, Zsambok CE. Decision Making in Action: Models and Methods. Norwood, NJ: Ablex Publishing; 1993.
32 Dijksterhuis AP, Nordgren LF. A theory of unconscious thought. Perspect Psychol Sci. 2006;1:95-109.
33 Wilson T. Strangers to ourselves: Discovering the adaptive unconscious. Cambridge, Mass: Belknap Press of Harvard University Press; 2004.
34 Reyna VF. How people make decisions that involve risk: A dual-process approach. Curr Dir Psychol Sci. 2004;13:60-66.
35 Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298:883-887.
36 Zajonc RB. Feeling and thinking: Preferences need no inferences. Am Psychol. 1980;35:151-175.
37 Schwarz N. Feelings as information: Moods influence judgments and processing strategies. In: T Gilovich, D Griffin, D Kahneman, eds. Heuristics and Biases: The Psychology of Intuitive Judgment. New York, NY: Cambridge University Press; 2002:534-547.
38 Gladwell M. Blink: The Power of Thinking Without Thinking. New York, NY: Little, Brown and Company; 2005.
39 Croskerry P. Critical thinking and decision making: Avoiding the perils of thin- slicing. Ann Emerg Med. 2006;48:720-722.
40 Groopman J. How Doctors Think. New York, NY: Houghton Mifflin Company; 2007.
41 Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838-1848.
42 Quirk M. Intuition and Metacognition in Medical Education: Keys to Developing Expertise. New York, NY: Springer Publishing Company; 2006.
43 Wiggins D. Deliberation and Practical Reasoning. Essays on Aristotle's Ethics. Berkeley, Calif: University of California Press; 1980:221-240.
44 Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med. 2007;121:S2-S23.
45 Croskerry P, Norman GR. Overconfidence in clinical decision making. Am J Med. 2007;121:S24-S29.
46 Stanovich KE. Distinguishing the reflective, algorithmic, and autonomous minds: Is it time for a tri-process theory? In: Evans J, Frankish K, eds. In Two Minds: Dual Processes and Beyond. Oxford, UK: Oxford University Press; 2009:55-88.
47 Reason J. Human Error. New York, NY: Cambridge University Press; 1990.
48 Gilbert DT, Pelham BW, Krull DS. On cognitive busyness: When person perceivers meet person receivers. J Pers Soc Psychol. 1988;54:733-740.
49 Gilbert DT, McNulty SE, Giulano TA, Benson JE, Blurry words and fuzzy deeds: The attribution of obscure behavior. J Pers Soc Psychol. 1992;62:18-25.
50 Gigerenzer G, Czerlinski J, Martignon L. How good are fast and frugal heuristics? In: Gilovich T, Griffin D, Kahneman D, eds. Heuristics and Biases: The Psychology of Intuitive Judgment. New York, NY: Cambridge University Press; 2002:559-581.
51 Nicholson S. Choice context and decision-making: An application to voter fatigue. Available at: ( http://www.allacademic.com/meta/...- ouverture dans une nouvelle fenêtre). Accessed April 20, 2009.
52 Krueger J, Funder DC. Towards a balanced social psychology: Causes, consequences and cures for the problem-seeking approach to social cognition and behavior. Behav Brain Sci. 2004;27:313-376.
53 Baron J. Thinking and Deciding. 3rd ed. New York, NY: Cambridge University Press; 2000.
54 Lieberman MD, Jarcho JM, Satpute AB. Evidence-based and intuition-based self-knowledge: An fMRI study. J Pers Soc Psychol. 2004;87:421-435.
55 Durmer JS, Dinges DF. Neurocognitive consequences of sleepdeprivation. Semin Neurol. 2005;25:117-129.
56 Croskerry P. The theory and practice of clinical decision-making. Can J Anesth. 2005;52(suppl 1):R1-R8.
57 Elstein AS. Clinical judgment: Psychological research and medical practice. Science. 1976;194:696-700.
58 Hamm RM. Theory about heuristic strategies based on verbal protocol analysis: The emperor needs a shave. Med Decis Making. 2004;24:681-686.
59 Poses RM, Cebul RD, Wigton RS. You can lead a horse to water-Improving physicians' knowledge of probabilities may not affect their decisions. Med Decis Making. 1995;15:65-75.
60 Bordage G. Why did I miss the diagnosis? Some cognitive explanations and educational implications Acad Med. 1999;74(10 suppl):S138-S143.
61 Bornstein BH, Emler AC. Rationality in medical decision making: A review of the literature on doctors' decision-making biases. J Eval Clin Pract. 2001;7:97-107.
62 Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005;330:781-783.
63 Croskerry P. Achieving quality in clinical decision making: Cognitive strategies and detection of bias. Acad Emerg Med. 2002;9:1184-1204.
64 Croskerry P. Diagnostic Failure: A Cognitive and Affective Approach. Advances in Patient Safety: From Research to Implementation. Rockville, Md: Agency for Health Care Research and Quality; 2006.
65 Croskerry P, Abbass A, Wu AW. How doctors feel: Affective issues in patients' safety. Lancet. 2008;372:1205-1206.
66 Croskerry P. The importance of cognitive errors in diagnosis and strategies to prevent them. Acad Med. 2003;78:1-6.
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Language: | English.
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Document Type: | Diagnostic Reasoning.
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Journal Subset: | Clinical Medicine. Health Professions.
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ISSN: | 1040-2446
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NLM Journal Code: | acm, 8904605
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DOI Number: | https://dx.doi.org/10.1097/ACM.0...- ouverture dans une nouvelle fenêtre
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