Checklists to Reduce Diagnostic Errors
Open accessAbstract
Diagnostic errors are common and can often be traced to physicians' cognitive biases and failed heuristics (mental shortcuts). A great deal is known about how these faulty thinking processes lead to error, but little is known about how to prevent them. Faulty thinking plagues other high-risk, high-reliability professions, such as airline pilots and nuclear plant operators, but these professions have reduced errors by using checklists. Recently, checklists have gained acceptance in medical settings, such as operating rooms and intensive care units. This article extends the checklist concept to diagnosis and describes three types of checklists: (1) a general checklist that prompts physicians to optimize their cognitive approach, (2) a differential diagnosis checklist to help physicians avoid the most common cause of diagnostic error--failure to consider the correct diagnosis as a possibility, and (3) a checklist of common pitfalls and cognitive forcing functions to improve evaluation of selected diseases. These checklists were developed informally and have not been subjected to rigorous evaluation. The purpose of this article is to argue for the further investigation and revision of these initial attempts to apply checklists to the diagnostic process. The basic idea behind checklists is to provide an alternative to reliance on intuition and memory in clinical problem solving. This kind of solution is demanded by the complexity of diagnostic reasoning, which often involves sense-making under conditions of great uncertainty and limited time.
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Checklists encourage analytic thinking instead of relying solely on intuition and memory, prompting clinicians to consciously examine their diagnostic approach.
“They encourage analytic thinking instead of relying solely on intuition and memory, prompting them to consciously examine their diagnostic approach [202,203].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [202]
The Diagnostic Checklists section (page unavailable) says the lists prompt physicians to consider a broad differential diagnosis and help prevent missed diagnoses. That supports deliberate consideration of alternatives, but the copy does not specifically say checklists replace reliance on intuition or memory or prompt clinicians to examine their diagnostic approach. (LLM, conf=0.82)
Experimental — accuracy not yet measuredChecklists are designed to guide diagnostic reasoning and act as cognitive aids that support clinicians.
“Checklists are designed to guide diagnostic reasoning and act as cognitive aids that support clinicians.”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [202]
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- Authors
- Ely, J. W., Graber, M. L., & Croskerry, P.
- Affiliations
- University of Iowa (US)
- Corresponding author
- Ely, John W.
- Venue
- Academic Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-03
- Volume
- 86
- Issue
- 3
- Pages
- 307-313
- ISSN
- 1040-2446 (ISSN-L)
- OpenAlex
- W2321464116
- Cited by
- 366
- References
- 65
- Citations by year
- 2026: 15 · 2025: 18 · 2024: 24 · 2023: 20 · 2022: 34 · 2021: 29 · 2020: 28 · 2019: 35 · 2018: 18 · 2017: 20 · 2016: 26 · 2015: 26 · 2014: 22 · 2013: 23 · 2012: 18
- FWCI
- 21.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Academic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Keywords
- diagnostic errors, checklists, cognitive biases, heuristics, differential diagnosis, diagnostic reasoning, clinical decision-making, error prevention, medical education
- MeSH terms
- Cognition, Decision Making, Diagnosis, Differential, Diagnostic Errors, Humans, Memory, Problem Solving, Checklist
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