Improving Diagnosis: Adding Context to Cognition
Open accessAbstract
Background: The environment in which clinicians provide care and think about their patients is a crucial and undervalued component of the diagnostic process. Content: In this paper, we propose a new conceptual model that links work conditions to clinician responses such as stress and burnout, which in turn impacts the quality of the diagnostic process and finally patient diagnostic outcomes. The mechanism for these interactions critically depends on the relationship between working memory (WM) and long-term memory (LTM), and ways WM and LTM interactions are affected by working conditions. Summary: We propose a conceptual model to guide interventions to improve work conditions, clinician reactions and ultimately diagnostic process, accuracy and outcomes. Outlook: Improving diagnosis can be accomplished if we are able to understand, measure and increase our knowledge of the context of care.
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Interruptions from environmental distractions lead to diagnostic errors and disruption of care transitions.
“Clinicians’ performance can be interrupted by frequent environmental distractions caused by noise, high pressure, and cognitive overload, leading to diagnostic errors and disruption of care transitions [297].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [297]
The 'Situated cognition' section says a distracted clinician facing a complex case and insufficient time is more likely to misdiagnose; the paper also describes interruptions and noise as burdens on working memory. It does not link these distractions to disruption of care transitions, and it frames diagnostic error as a risk rather than an inevitable result. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFrequent environmental distractions caused by noise, high pressure, and cognitive overload can interrupt clinicians' performance.
“Clinicians’ performance can be interrupted by frequent environmental distractions caused by noise, high pressure, and cognitive overload, leading to diagnostic errors and disruption of care transitions [297].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [297]
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Flagged first, then by citations
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Cited by
Sorted by citations
Parsons, A. S., Wijesekera, T. P., Olson, A. P. J., Torre, D., Durning, S. J., & Daniel, M. (2025) · Medical Teacher · doi:10.1080/0142159x.2024.2359963 · Cited by 12 · see citing works
Self-citationToward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors
Yen, C., Epling, J. W., Rockwell, M., & Vaughn-Cooke, M. (2026) · Diagnostics · doi:10.3390/diagnostics16020347 · Cited by 6 · see citing works
- Authors
- Linzer, M., Sullivan, E. E., Olson, A. P. J., Khazen, M., Mirica, M., & Schiff, G. D.
- Affiliations
- University of Minnesota (US)
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Linzer, Mark
- Venue
- Diagnosis
- Publisher
- Walter de Gruyter GmbH
- Published
- 2022-08-22
- Volume
- 10
- Issue
- 1
- Pages
- 4-8
- ISSN
- 2194-8011 (ISSN-L)
- 2194-802X
- OpenAlex
- W4294093976
- Cited by
- 10
- References
- 3
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 3
- FWCI
- 2.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diagnosis (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Gordon and Betty Moore Foundation
- National Institutes of Health
- Agency for Healthcare Research and Quality
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- diagnostic process, working conditions, clinician stress, burnout, working memory, long-term memory, context of care, diagnostic accuracy, conceptual model
- MeSH terms
- Burnout, Professional, Cognition, Humans, Memory, Short-Term
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