Read on Twitter
Next I'll be tweeting the session on "Diagnostic Errors: Seeing the Blindspot of Healthcare Delivery!" First up is Dr. Molly Hayes with "What are Diagnostic Errors?"! #CHEST2020
Let's start with Mr. G's Case... #CHEST2020
What are diagnostic errors? "Improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative." #CHEST2020
Diagnostic errors can be from a delayed diagnosis, missed diagnosis, or wrong diagnosis! #CHEST2020
Diagnostic errors are a public health problem! #CHEST2020
Heuristics and cognitive biases #CHEST2020
This is a great book she recommends. #CHEST2020
There are a ton of different cognitive biases, but these are a few of the most common. #CHEST2020
The availability bias is something we're seeing more of with COVID now. #CHEST2020
Anchoring happens with an insufficient initial anchor leads to biased estimates. #CHEST2020
Framing can be helpful but can also lead to diagnostic errors! #CHEST2020
Now let's go back to our case. There were details on the case that you weren't told on round because they didn't fit the picture. There was an anchoring bias and framing that led to the wrong diagnosis! #CHEST2020
Next up we have "Why do Diagnostic Errors Occur" with Dr. Jayshil Patel! #CHEST2020
The 1999 IOM report told us that there were a ton of deaths from medical errors. #CHEST2020
Diagnostic error can come from no fault errors, cognitive errors, or system errors. #CHEST2020
When you look at the theory of decision making there is a normative component of how decisions SHOULD be made, and a descriptive component of how decisions actually are made. #CHEST2020
If you don't stop and let system 2 check system 1 you can end up in trouble. #CHEST2020
Heuristics are system 1 and they are helpful! But we need to stop and check them! #CHEST2020
The complexity of a system will determine whether a task will induce intuition or analysis. #CHEST2020
In a busy ICU we can have diagnostic errors due to multiple cognitive biases and system factors. #CHEST2020
Here's a summary of his talk. Our system 1 decision making leads to cognitive errors but system 2 is the path to expertise. #CHEST2020
Next up is Dr. Paul Bergl ( @PaulBerglMD) with "Practical Strategies to Minimize Diagnostic Errors in Your ICU and Training Program." #CHEST2020
Situated cognition states that there are three main domains that affect diagnostic errors: patient, physician, and practice factors. Two of these (physician and practice) are under our influence. #CHEST2020
Key recommendations for error reduction #CHEST2020
How can we keep patients at the center? Families should be involved! #CHEST2020
We need to democratize rounds. Two heads are better than one, and second review reduced errors! #CHEST2020
How can we reduce distractions and cognitive load? Use checklists, reduce non-diagnostic decisions, start with the sickest patients that require the most thought. #CHEST2020
Optimize health IT to help with decision support. #CHEST2020
One thing we can do to help with decision making is to embrace uncertainty and realize that it's always going to be there. #CHEST2020
These are strategies for reducing uncertainty. #CHEST2020
The testing threshold (whether to test or treat empirically) depends on the diagnosis probability. #CHEST2020
Whether to test first or empirically treat will vary case to case based on the risks. #CHEST2020
Tips for improving cognition. Expertise develops through feedback! #CHEST2020
Tips for improving education on decision making. #CHEST2020
Parting thoughts! #CHEST2020
