Electronic differential diagnostic support (EDS) are decision aids that suggest one or more differential diagnoses based on clinical data entered by the clinician. The generated list may prompt the clinician to consider additional diagnoses. This study simulated the use of one EDS, Isabel, in the emergency department to identify barriers and supports to its effectiveness. Four themes emerged. Notably, some physicians thought the EDS-generated differentials could reduce bias while others suggested it could introduce bias.

Misdiagnosis of heart failure can lead to serious patient harm. This article reviews the cognitive psychology of diagnostic reasoning in cardiology. Strategies for educators, students, and researchers to reduce cardiovascular misdiagnosis are presented.

… used early or late in the diagnostic process. … Sibbald M, Monteiro S, Sherbino J, et al. Should electronic differential diagnosis …

Physicians often experience considerable emotional distress, shame, and self-doubt after being involved in a medical error. Based on in-depth interviews with emergency, internal, and family medicine physicians, this qualitative study explores how physicians experience and learn from preventable medical errors. In addition to exploring themes around the physician’s emotional growth and professional development, the authors discuss the value of sharing and learning from these experiences for colleagues and trainees.  

This commentary reviews five differences between diagnostic reasoning and patient management reasoning, such as the changing nature of management over time and the team-based nature of the activity. The authors recommend areas of research needed to further understand patient management reasoning.

Decision making is typically either intuitive or analytical. This commentary discusses the two types of decision making, how heuristics and cognitive biases affect diagnostic reasoning, and strategies to reduce diagnostic error.

Providing eight ambiguous clinical vignettes to generalist physician members of the Society to Improve Diagnosis in Medicine, this study found participants did not agree on whether cognitive biases were or were not present. When the outcome of the vignette implied an incorrect diagnosis, respondents reported twice as many biases, suggesting that physician judgments are strongly influenced by hindsight bias.

This medical education study found that self-reflection only minimally improved diagnostic accuracy among medical residents in a simulation setting. These results suggest that a more robust cognitive debiasing curriculum may be needed to enhance diagnostic decision making.

This study used written medical cases to examine whether simulated time pressure or interruptions affect diagnostic accuracy among resident and attending emergency medicine physicians. While the experienced physicians answered the questions more quickly and accurately compared to resident physicians, diagnostic accuracy was not compromised by time pressure or interruptions for either group in this study.

Resident physicians instructed to be "careful, thorough, and reflective" when answering clinical vignette questions took 30% more time with each case but did not have better diagnostic accuracy compared with residents who were told to answer as quickly as possible. These results suggest diagnostic errors are not simply related to insufficient attention or time.

This commentary highlights the need to evaluate diagnostic reasoning in emergency medicine to address gaps and motivate research exploring factors that impair assessment.

… when controlling for clinicians' baseline knowledge. … Sherbino J, Dore KL, Wood TJ, et al. The relationship between …

This article reviews evidence on the cognitive origins of diagnostic errors and examines theories regarding both clinical reasoning and dual-process thinking.