The cognitive psychology of missed diagnoses
The cognitive psychology of missed diagnoses
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DOI：
10.7326/0003-4819-142-2-200501180-00010
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发表时间：
2005-01-18
影响因子：
39.2
通讯作者：
Redelmeier, DA
中科院分区：
文献类型：
--
作者：
Redelmeier, DA
认知心理学是一门研究人们如何推理、形成判断和做出决定的科学。本病例涉及一名被诊断为咽炎的患者，由于一系列认知捷径而错过了骨髓炎的最终诊断。这些错误包括可用性启发式（人们通过容易想到的例子来判断可能性）、锚定启发式（人们坚持最初的印象）、框架效应（人们根据信息的呈现方式做出不同的决定）、盲目服从（人们在面对权威时停止思考）和过早关闭（不寻求几种替代方案）。与其试图完全消除认知捷径（这通常对临床医生很有好处），不如意识到常见的错误可能会导致患者护理的持续改善。
Cognitive psychology is the science that examines how people reason, formulate judgments, and make decisions. This case involves a patient given a diagnosis of pharyngitis, whose ultimate diagnosis of osteomyelitis was missed through a series of cognitive shortcuts. These errors include the availability heuristic (in which people judge likelihood by how easily examples spring to mind), the anchoring heuristic (in which people stick with initial impressions), framing effects (in which people make different decisions depending on how information is presented), blind obedience (in which people stop thinking when confronted with authority), and premature closure (in which several alternatives are not pursued). Rather than trying to completely eliminate cognitive shortcuts (which often serve clinicians well), becoming aware of common errors might lead to sustained improvement in patient care.