Avoiding Cognitive Errors in Clinical Decision Making
Authors: Robert L. Trowbridge, Joseph J. Rencic, Thilan P. Wijesekera, Andrew P.J. Olson
Journal: Annals of Internal Medicine (2020)

Letters20 October 2020Avoiding Cognitive Errors in Clinical Decision MakingRobert L. Trowbridge, MD, Joseph J. Rencic, MD, Thilan P. Wijesekera, MD, MHS, and Andrew P.J. Olson, MDRobert L. Trowbridge, MDMaine Medical Center and Tufts University School of Medicine, Portland, Maine, and Boston, Massachusetts (R.L.T.)Search for more papers by this author, Joseph J. Rencic, MDBoston Medical Center, Boston, Massachusetts (J.J.R.)Search for more papers by this author, Thilan P. Wijesekera, MD, MHSYale School of Medicine, New Haven, Connecticut (T.P.W.)Search for more papers by this author, and Andrew P.J. Olson, MDUniversity of Minnesota, Minneapolis, Minnesota (A.P.O.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1059 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Although we are heartened by the attention that Restrepo and colleagues (1) paid to clinical decision making, we believe that several important points about the role of cognitive bias should be addressed.First, we disagree with the characterization of many cognitive errors as “errors of ego” and find the description unnecessarily pejorative. A clinician's ego may play a role in some errors, but there are probably more powerful drivers that encourage predispositions to respond and that adversely affect decision making. For example, the expectation on the part of society, patients, and clinicians themselves to establish a diagnosis ...References1. Restrepo D, Armstrong KA, Metlay JP. Annals clinical decision making: avoiding cognitive errors in clinical decision making. Ann Intern Med. 2020;172:747-51. [PMID: 32311734]. doi:10.7326/M19-3692 LinkGoogle Scholar2. McLaughlin K, Eva KW, Norman GR. Reexamining our bias against heuristics. Adv Health Sci Educ Theory Pract. 2014;19:457-64. [PMID: 24889994] doi:10.1007/s10459-014-9518-4 CrossrefMedlineGoogle Scholar3. Young JQ, Van Merrienboer J, Durning S, et al. Cognitive load theory: implications for medical education: AMEE guide no. 86. Med Teach. 2014;36:371-84. [PMID: 24593808] doi:10.3109/0142159X.2014.889290 CrossrefMedlineGoogle Scholar4. Zwaan L, Monteiro S, Sherbino J, et al. Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workups. BMJ Qual Saf. 2017;26:104-10. [PMID: 26825476] doi:10.1136/bmjqs-2015-005014 CrossrefMedlineGoogle Scholar5. Lambe KA, O'Reilly G, Kelly BD, et al. Dual-process cognitive interventions to enhance diagnostic reasoning: a systematic review. BMJ Qual Saf. 2016;25:808-20. [PMID: 26873253] doi:10.1136/bmjqs-2015-004417 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Maine Medical Center and Tufts University School of Medicine, Portland, Maine, and Boston, Massachusetts (R.L.T.)Boston Medical Center, Boston, Massachusetts (J.J.R.)Yale School of Medicine, New Haven, Connecticut (T.P.W.)University of Minnesota, Minneapolis, Minnesota (A.P.O.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1059. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals Clinical Decision Making: Avoiding Cognitive Errors in Clinical Decision Making Daniel Restrepo , Katrina A. Armstrong , and Joshua P. Metlay Avoiding Cognitive Errors in Clinical Decision Making Daniel Restrepo , Katrina A. Armstrong , and Joshua P. Metlay Avoiding Cognitive Errors in Clinical Decision Making Daniel M. Musher Metrics 20 October 2020Volume 173, Issue 8Page: 678-679KeywordsConflicts of interestDecision makingDisclosureMotivationReasoning ePublished: 20 October 2020 Issue Published: 20 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...