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Clinical cognition and diagnostic error: applications of a dual process model of reasoning

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Abstract

Both systemic and individual factors contribute to missed or delayed diagnoses. Among the multiple factors that impact clinical performance of the individual, the caliber of cognition is perhaps the most relevant and deserves our attention and understanding. In the last few decades, cognitive psychologists have gained substantial insights into the processes that underlie cognition, and a new, universal model of reasoning and decision making has emerged, Dual Process Theory. The theory has immediate application to medical decision making and provides an overall schema for understanding the variety of theoretical approaches that have been taken in the past. The model has important practical applications for decision making across the multiple domains of healthcare, and may be used as a template for teaching decision theory, as well as a platform for future research. Importantly, specific operating characteristics of the model explain how diagnostic failure occurs.

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Notes

  1. In contrast to the modern (psychological) view of intuition as an unconscious, automatic, biased process that may fall short of rationality, the ancient (philosophical) view saw it as a superior form of intelligent and rational reasoning reflecting a supreme state of mind. The change appears to have occurred quite recently in the early twentieth century, influenced by the work of the French philosopher Henri Bergson (Henden 2004).

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Correspondence to Pat Croskerry.

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Croskerry, P. Clinical cognition and diagnostic error: applications of a dual process model of reasoning. Adv in Health Sci Educ 14 (Suppl 1), 27–35 (2009). https://doi.org/10.1007/s10459-009-9182-2

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