Compelling lecture on clinical decision making and diagnostic error

Today’s post on Paul Levy’s blog led me back to this November post, where he posted this 35 minute lecture. I was going to write about the subject, embedding this at the end, but you have to absorb this first. Clinicians and patients alike, please watch.

I think if we want to improve this aspect of medicine, it’s essential to understand the evidence presented here. It documents some of the major challenges in diagnosis, which suggest that we shouldn’t expect clinicians to be perfect and clinicians shouldn’t expect us to think they are.

The lecturer is Pat Croskerry, Professor in Emergency Medicine at Dalhousie University, Halifax, Nova Scotia. Levy’s post says:

Croskerry’s exposition compares intuitive versus rational (or analytic) decision-making. Intuitive decision-making is used more often. It is fast, compelling, requires minimal cognitive effort, addictive, and mainly serves us well. It can also be catastrophic in that it leads to diagnostic anchoring that is not based on true underlying factors.

He says we should explicitly teach decision making skills in medical training.  I’ll add: if we all recognize the difficulty of perfect decisions, we can work together to improve the odds – with more participation, less blaming, and overall better outcomes. And, I hope, less unwarranted stress for clinicians who are doing the best they can.


Posted in: reforming hc | shared decision making | Why PM




9 Responses to “Compelling lecture on clinical decision making and diagnostic error”

  1. kgapo says:

    Hi Dave, I am glad you digged this video on Paul Levy’s blog!! I read him too but not daily…

    I have just finished reading Jerome Groopman’s “How Doctors Think” and you bet who was most quoted regargding how he goes about diagnosis: Pat Croskerry!

    So, I just wanted to let you know before watching the video. How Doctors Think is a MUST READ for both patients and doctors.

  2. Hello Dave,
    A great video. Thanks – it puts meat on the bone to my recent reading and work. I read Groopman’s book when it first came out and quote him regularly. I agree – a MUST read, but it is very scary in places.

  3. “Reflective practice”
    His whole message is what educators have been working on this past five+ years to adapt traditional curriculums and learning deliver methods to the new brain research. “Teaching with the brain in mind”

    In the information age, vital info needed can be available at our fingertips within seconds. I hazard to say, to foster clinicians who can “think outside of the box” they need more training in Crosskerry’s apporach than the old, and becoming less relevant memorization technique.

  4. Excellent lecture, good comment, Dave.

    It’s important to remember that we patients exercise the same bias toward intuitive responses; this is especially true when we are upset or feeling ill. And our rational decision making is usually considerably less substantively informed than our clinicians.’

    Shared decision making means that we and our clinicians should all be aware of this tendency to favor the intuitive and, as Crosskerry notes, “know what we have to be careful of.”

    A bit of a heavy lift, no?

    • Jessie, I couldn’t agree more – especially “when we’re upset or feeling ill,” and our lack of the clinician’s substantive background. I sure didn’t know beans about kidney cancer treatments.

      What a pleasure to see you here! (For those who don’t already know, Jessie was founding co-editor-in-chief of the Journal of Participatory Medicine, and has a phenomenal career as an advocate for people being enaged in their health – as her domain suggests.)

      She also has plenty of experience on the receiving end of healthcare; here is our September post on her fourth cancer diagnosis & treatment. And here she is … she stepped down as co-editor, but is back on top of life.

  5. Paul Levy says:

    Terrific point, Jessie!

  6. […] Compelling lecture on clinical decision making and diagnostic error […]

  7. […] post was written by e-Patient Dave on March 20, 2011 and appeared on http://www.e-patients-net. Today’s post on Paul Levy’s blog led me back to this November post, where he posted this 35 […]

  8. I just had the privilege of seeing Dr. Croskerry live, in a special lecture at Beth Israel Deaconess in Boston. His subject was “What is the best hospital environment for safe clinical decision making?” VERY deep thinking, related to the video above but different, and completely unlike anything I’ve ever heard from others in analyzing why things turn out wrong sometimes.

    Lots to think about before blogging about it.

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