Abstract: How neurologists think ... missed diagnoses

[jimmylegs]

How neurologists think: A cognitive psychology perspective on missed diagnoses
http://onlinelibrary.wiley.com/doi/10.1 ... =false#fn1
Physicians use heuristics or shortcuts in their decision making to help them sort through complex clinical information and formulate diagnoses efficiently. Practice would come to a halt without them. However, there are pitfalls to the use of certain heuristics, the same ones to which humans are prone in everyday life. It may be possible to improve clinical decision making through techniques that minimize biases inherent in heuristics. Five common clinical heuristics or other sources of cognitive error are illustrated through neurological cases with missed diagnoses, and literature from cognitive psychology and medicine are presented to support the occurrence of these errors in diagnostic reasoning as general phenomena. Articulation of the errors inherent in certain common heuristics alerts clinicians to their weaknesses as diagnosticians and should be beneficial to practice. Analysis of cases with missed diagnoses in teaching conferences might proceed along formal lines that identify the type of heuristic used and of inherent potential cognitive errors. Addressing these cognitive errors by becoming conscious of them is a useful tool in neurologic education and should facilitate a career-long process of continuous self-improvement

full text access would be so nice. I can't wait to get back in school :S lol

[jimmylegs]

wait it was right there under my nose!
http://www.ajustnhs.com/wp-content/uplo ... y-2010.pdf

[Cholderby]

I love this! I mean I love the exposure of this, not that it's problematic. Yk what I mean.

About a week ago the NY Times ran a story about a book "When Doctors Don't Listen" which could double as the subtitle of my life last month.

http://www.nytimes.com/2013/04/02/healt ... .html?_r=0

The article, and my experience being diagnosed with MS made me particularly happy I have a DO as a PCP. They are trained to think in a different manner than MDs and seem less likely to fall into that trap.

[jimmylegs]

i liked it too my docs got stuck in 'computer says so' land when they were doing the diff dx. how could computer be wrong? but it was.. glad you have a good doc c

[Cece]

The use of heuristics could be fine if you have typical MS but not fine if yours is atypical.

[jimmylegs]

not to mention, what is 'typical' ms exactly...

[centenarian100]

not to mention, what is 'typical' ms exactly...

Maybe a 25 yo female with 1 episode of R optic neuritis and 1 episode of cervical transverse myelitis with 7 typical "dawson's fingers" on MRI brain, 5 oligoclonal bands restricted to the CSF, and clinical uhtoff's phenomenon and L'hermitte's sign.