Visual perception, cognition, and error in dermatologic diagnosis: Diagnosis and error - 09/11/19

Doi : 10.1016/j.jaad.2018.12.072

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

^∗Reprint requests: Eve J. Lowenstein, MD, PhD, SUNY Health Science Center at Brooklyn, Dermatology, 450 Clarkson Ave, Box 46, Brooklyn, NY 11203.SUNY Health Science Center at BrooklynDermatology450 Clarkson Ave, Box 46BrooklynNY11203

Abstract

Diagnostic error in dermatology is a large practice gap that has received little attention. Diagnosis in dermatology relies heavily on a heuristic approach that is responsible for our perception of clinical findings. To improve our diagnostic accuracy, a better understanding of the strengths and limitations of heuristics (cognitive shortcuts) used in dermatology is essential. Numerous methods have been proposed to improve diagnostic accuracy, including brain training, reducing cognitive load, and getting feedback and second opinions. Becoming comfortable with the uncertainty intrinsic to medicine is essential. Ultimately, the practice of metacognition, or thinking about how we think, can offer corrective insights to improve accuracy in diagnosis.

Le texte complet de cet article est disponible en PDF.

Key words : cognitive error, diagnostic error, heuristic, metacognition, patient safety, visual intelligence

Plan

How we err: Why this subject?

Did I see it (as completely as possible)?

Dermatologic heuristics

The heuristics of context and semantics

Methods to reduce diagnostic error in dermatology

Brain training

Reducing cognitive load

Importance of feedback

Reducing discomfort with uncertainty

Metacognition

Conclusion

	Funding sources: None.
	Conflicts of interest: None disclosed.
	Date of release: December 2019
	Expiration date: December 2022
	Previously presented in poster format and in grand rounds lecture format at multiple meetings in the United States, Europe, and the Middle East.