Visual perception, cognition, and error in dermatologic diagnosis: Key cognitive principles - 09/11/19

Doi : 10.1016/j.jaad.2018.10.082

Christine J. Ko, MD ^a,^b,^⁎ , Irwin Braverman, MD ^a, Richard Sidlow, MD ^c,^d, Eve J. Lowenstein, MD, PhD ^e,^f,^g
^a Department of Dermatology, Yale University Medical School, New Haven, Connecticut
^b Department of Pathology, Yale University Medical School, New Haven, Connecticut
^c Staten Island University Hospital/Northwell Health, Staten Island, New York
^d Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
^e Department of Dermatology, SUNY Health Science Center at Brooklyn, Brooklyn, New York
^f Kings County Hospital Center, Brooklyn, New York
^g South Nassau Dermatology PC, Oceanside and Long Beach, New York

^∗Correspondence to: Christine J. Ko, MD, Yale University School of Medicine, Department of Dermatology, 333 Cedar St, PO Box 208059, New Haven, CT 06520.Yale University School of MedicineDepartment of Dermatology333 Cedar St, PO Box 208059New HavenCT06520

Abstract

Dermatologic diagnosis relies on vision primarily and auditory and verbal input secondarily. Accurate dermatologic diagnosis is predicated on seeing and perceiving a skin finding, categorizing and naming the finding correctly, and comparing the visual data and data obtained from the totality of the clinical encounter (ie, from other sensory modalities) with one's working mental database of dermatologic diagnoses. The baseline assumption—which is false—is that a dermatologist is an expert at each of the aforementioned steps and transitions sequentially between them seamlessly in an error-free fashion. Each of these steps has inherent challenges, and the transitions between steps can also be problematic. In part 1 of this 2-part report, we describe the pitfalls associated with visual recognition. In part 2, we discuss cognitive heuristics as they relate to the dermatologic diagnostic process and prevention of diagnostic error.

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Key words : cognition, dermatologic diagnosis, error, gestalt, heuristic, inattentional blindness, metacognition, visual diagnosis, visual perception, visual recognition