Medical Errors - Dr. Gibbs

> Up to 100,000 deaths in the US hospitals each yr related to medical errors

> Types of errors

    1. Affective Errors  - idea that we may treat a patient differently because there is something

        about them or about the circumstance that evokes either a negative or positive emotion

            - Positive - more time spent; some literature that we may avoid painful procedures

            - Negative - premature closure, less time, less care, less analgesia

     2. Cognitive errors - Faulty knowledge, faulty data gathering, faulty synthesis, affective

         errors, external factors

            - Feedback failure - if you don’t know you screw up you don’t change your

              thought processes or practices = Confirmation bias;  want to avoid over recalibration too

           - System 1 thinking - Illness script - pattern recognition comes from education and

              experience

                    > Fast but can be unreliable, dependent on experience and not all illness follows illness scripts

           - System 2 Thinking - Cognitive Checkpoints - specific tests


Cognitive Dispositions

• Triage cueing, psych out error, yin yang out (patient has already been evaluated a lot - therefore there’s nothing wrong)

• Cognitive transfer; diagnostic momentum

           - Premature closure = most common error in acute care medicine

• Availability bias - recent experience with disease inflates possibility of it being diagnosed
• Posterior probability error - if patient has had something before you’re more likely to think thats what they have again
  

Strategies to avoid error

    a. Admitting you have a problem is the first step

    b. Improve accuracy of judgements through cognitive aids

    c. Simulation

    d. EVERYTHING around you on any given day will influence how you take care of your next patient

    e. Metacognition - “thinking about thinking” -requires self awareness, ability to be self critical, & ability to introduc deliberate          pause during the decision making process


Train yourself to do a diagnostic pause - think about serious or alternative diagnosis, evaluate feelings, make sure there’s no extraneous information you’re missing, evaluate if theres anything today that’s impacting your decisions

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