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Research on the way doctors think and (mis) diagnose


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"Croskerry, who is sixty-four years old, began his career as an experimental psychologist, studying rats? brains in the laboratory. In 1979, he decided to become a doctor, and, as a medical student, he was surprised at how little attention was paid to what he calls the ?cognitive dimension? of clinical decision-making?the process by which doctors interpret their patients? symptoms and weigh test results in order to arrive at a diagnosis and a plan of treatment. Students spent the first two years of medical school memorizing facts about physiology, pharmacology, and pathology; they spent the last two learning practical applications for this knowledge, such as how to decipher an EKG and how to determine the appropriate dose of insulin for a diabetic. Croskerry?s instructors rarely bothered to describe the mental logic they relied on to make a correct diagnosis and avoid mistakes.


In 1990, Croskerry became the head of the emergency department at Dartmouth General Hospital, and was struck by the number of errors made by doctors under his supervision. He kept lists of the errors, trying to group them into categories, and, in the mid-nineties, he began to publish articles in medical journals, borrowing insights from cognitive psychology to explain how doctors make clinical decisions?especially flawed ones?under the stressful conditions of the emergency room. ?Emergency physicians are required to make an unusually high number of decisions in the course of their work,? he wrote in ?Achieving Quality in Clinical Decision Making: Cognitive Strategies and Detection of Bias,? an article published in Academic Emergency Medicine, in 2002. These doctors? decisions necessarily entail a great deal of uncertainty, Croskerry wrote, since, ?for the most part, patients are not known and their illnesses are seen through only small windows of focus and time.? By calling physicians? attention to common mistakes in medical judgment, he has helped to promote an emerging field in medicine: the study of how doctors think."

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