Thinking about errors

Thank you for the informative research article classifying errors in family medicine.1

I would like to draw attention to a related article in the New Yorker magazine in January 29, 2007: “What’s the Trouble? How doctors think,” by Jerome Groopman.2 This article outlines the work of Pat Croskerry, an emergency physician in Halifax, NS, with a background in psychology. He has published articles borrowing insights from cognitive psychology to explain how doctors make clinical decisions, especially how they make errors in diagnoses. To make diagnoses, most doctors rely on shortcuts known in psychology as “heuristics.” Croskerry has divided errors in diagnosis into 3 categories.

• Representativeness errors are made when thinking is overly influenced by what is typically true.

• Availability errors are made when judgments about patients are unconsciously influenced by the symptoms and illnesses of patients just seen.

• Affective errors arise from a tendency to make decisions based on what we wish were true.

• Croskerry makes the important point that how doctors think can affect their success as much as how much they know or how much experience they have.

• Copyright© the College of Family Physicians of Canada