The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / How a Rheumatologist Thinks: Cognition and Diagnostic Errors in Rheumatology

How a Rheumatologist Thinks: Cognition and Diagnostic Errors in Rheumatology

November 1, 2010 • By Dennis J. Boyle, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

The Institute of Medicine has reported that each year up to 98,000 deaths result from iatrogenic injury and error.1 Autopsy series have suggested a 15% error rate in the practice of medicine. These numbers are surprising and concerning and raise important questions about how we practice medicine. What kind of errors do we make as providers? How can we reduce the incidence of such occurrences?

You Might Also Like
  • Reforms Needed to Address Medical Diagnostic Errors
  • Parents Often Catch Hospital Errors Doctors Missed
  • Avoid Errors: Insights into Ensuring Accurate Data in EHRs
Explore This Issue
November 2010
Also By This Author
  • Medication Non-Adherence by Rheumatology Patients & What Rheumatologists Can Do

Graber et al created a taxonomy that can help understand the issue of medical error.2 The investigators evaluated 100 internal-medicine diagnostic errors identified through quality assurance and autopsy discrepancies. Approximately half of the errors were diagnostic in nature and related to poor data gathering and faulty synthesis of information. The other half of the errors were systems issues, which were defined as technical failures as well as organization and policy issues such as abnormal tests not being communicated to the patient. There were six errors for each case reviewed; often, both cognition and systems issues were involved.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Rheumatology is considered the quintessential diagnostic specialty. Let’s look at what’s known about the cognitive part of this problem. How do clinicians diagnose illness, and what contributes to missed opportunities in this area of patient care?

Cognition

The diagnosis of medical conditions by providers requires a combination of experience, knowledge, and acumen. Critical thinking is at the core of this process and requires us to collect information, work through a problem, and reach a reasonable conclusion. Recent advances in cognitive psychology have provided a theoretical framework to understand decision making. As far back as Plato, the brain was felt to be divided into two components: a rational reasoning part and an emotional area with the rational in charge. More recently, it was thought that the cerebral cortex was the computer and the deeper limbic system was the area shared with animals, the instinctive emotional area. Cognitive theory now shows that these brain areas have evolved in unison and that there are really two systems that work together for decision making.3

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

In our day-to-day professional life, clinicians move between the two styles of decision making. Efficient doctoring requires frequent use of heuristics and occasional reliance on System II reasoning.

System I

The first diagnostic system, System I, involves pattern recognition and originates in the deeper part of the brain in dopamine-rich neurons. This part of the brain is an instinctual area that integrates life experiences, senses, emotions, and feelings and comes to an intuitive conclusion. Everyday life is full of such responses. Your choices regarding the color of your car or the person you marry are often gut-level decisions. Research has shown that this brain area is much more sophisticated than previously appreciated.

Pages: 1 2 3 4 5 | Single Page

Filed Under: Professional Topics, Safety Tagged With: Diagnosis, Diagnostic Criteria, Errors, Quality, rheumatologyIssue: November 2010

You Might Also Like:
  • Reforms Needed to Address Medical Diagnostic Errors
  • Parents Often Catch Hospital Errors Doctors Missed
  • Avoid Errors: Insights into Ensuring Accurate Data in EHRs
  • The Diagnostic View: Assess Your Rheumatology Knowledge

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.