A Primer on Cognitive Errors Illustrated Through the Lens of a Neurosurgical Practice
Open accessAbstract
Problem Statement: Diagnostic error is often attributed to cognitive errors, including biased thinking patterns, rather than knowledge or data limitations, and education on cognitive bias deserves review in all spheres of practice. Background: The cognitive biases of practitioners create an inherent fallibility in recognizing and treating medical conditions. Awareness of cognitive errors is valuable for mitigating risk of diagnostic error. The impact of cognitive error is substantial in the management of neurosurgically relevant disease. Remarkably broad differential diagnoses often accompany neurologic symptoms. Both focal and non-focal symptoms lend themselves to diagnostic inertia that contributes to errors. Further, initial diagnostic direction can be inaccurate in the involved biological system, anatomic localization, and the pathologic process; thus delaying diagnosis and potentially courting severe consequences. The authors present neurosurgical cases to illustrate the major types of unconscious cognitive errors in medicine using clinically relevant vignettes. Strategies to mitigate cognitive error are also reviewed. Application/Recommendations: Awareness of the types of cognitive errors and de-biasing strategies are valuable to avoid faulty estimation of disease likelihood, avoid overlooking all relevant possibilities, and mitigate error in critical thinking. Recognition that all clinicians are vulnerable to cognitive error exposes the importance of strategies to reduce biases. Efforts to reduce error in medicine can be approached strategically by working to reduce bias and increase discipline in clinical reasoning.
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Clinicians exhibit anchoring bias by placing excessive weight on initial information or salient symptom features, focusing on confirming their initial assumption and concluding the diagnosis without thoroughly investigating other alternative possibilities.
“Clinicians exihit this bias by placing excessive weight on the initial information they receive or salient symptom features a patient presents, focusing on confirming their initial assumption during the diagnostic process and concluding the diagnosis without thoroughly investigating other alternative possibilities [97,98].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [98]
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Cites
The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them
Croskerry, P. (2003) · Academic Medicine · doi:10.1097/00001888-200308000-00003 · Cited by 1,675 · see citing works
Cognitive Load Theory: Implications for medical education: AMEE Guide No. 86
Young, J. Q., Van Merrienboer, J., Durning, S., & Ten Cate, O. (2014) · Medical Teacher · doi:10.3109/0142159x.2014.889290 · Cited by 935 · see citing works
Promoting a Culture of Safety as a Patient Safety Strategy
Weaver, S. J., Lubomksi, L. H., Wilson, R. F., Pfoh, E. R., Martinez, K. A., & Dy, S. M. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-5-201303051-00002 · Cited by 622 · see citing works
Cognitive debiasing 1: origins of bias and theory of debiasing
Croskerry, P., Singhal, G., & Mamede, S. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001712 · Cited by 605 · see citing works
Cognitive interventions to reduce diagnostic error: a narrative review
Graber, M. L., KISSAM, S. M., Payne, V. L., Meyer, A. N. D., Sorensen, A. V., Lenfestey, N. F., Tant, E. M., Henriksen, K., LaBresh, K. A., & Singh, H. (2012) · BMJ Quality & Safety · doi:10.1136/bmjqs-2011-000149 · Cited by 448 · see citing works
Cognitive debiasing 2: impediments to and strategies for change
Croskerry, P., Singhal, G., & Mamede, S. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-001713 · Cited by 419 · see citing works
Mamede, S., van Gog, T., van den Berge, K., Rikers, R. M. J. P., van Saase, J. L. C. M., van Guldener, C., & Schmidt, H. G. (2010) · JAMA · doi:10.1001/jama.2010.1276 · Cited by 374 · see citing works
Royce, C. S., Hayes, M. M., & Schwartzstein, R. M. (2019) · Academic Medicine · doi:10.1097/acm.0000000000002518 · Cited by 242 · see citing works
Debiasing Health-Related Judgments and Decision Making: A Systematic Review
Ludolph, R. A., & Schulz, P. J. (2017) · Medical Decision Making · doi:10.1177/0272989x17716672 · Cited by 158 · see citing works
Better clinical decision making and reducing diagnostic error
Croskerry, P., & Nimmo, G. R. (2011) · The Journal of the Royal College of Physicians of Edinburgh · doi:10.4997/jrcpe.2011.208 · Cited by 148 · see citing works
Twelve tips for teaching avoidance of diagnostic errors
Trowbridge, R. L. (2008) · Medical Teacher · doi:10.1080/01421590801965137 · Cited by 126 · see citing works
Self-citationReflecting on Diagnostic Errors: Taking a Second Look is Not Enough
Monteiro, S., Sherbino, J., Patel, A., Mazzetti, I., Norman, G. R., & Howey, E. (2015) · Journal of General Internal Medicine · doi:10.1007/s11606-015-3369-4 · Cited by 67 · see citing works
The Assessment of Reasoning Tool (ART): structuring the conversation between teachers and learners
Thammasitboon, S., Rencic, J. J., Trowbridge, R. L., Olson, A. P. J., Sur, M., & Dhaliwal, G. (2018) · Diagnosis · doi:10.1515/dx-2018-0052 · Cited by 41 · see citing works
Self-citationPreventing Diagnostic Errors in Primary Care.
Ely, J., & Graber, M. L. (2016) · PubMed · Cited by 20 · see citing works
Becoming a teacher of clinical reasoning
Trowbridge, R. L., & Olson, A. P. J. (2018) · Diagnosis · doi:10.1515/dx-2018-0004 · Cited by 8 · see citing works
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Toward 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
- Florman, J. E., Almeder, L., & Trowbridge, R.
- Affiliations
- Maine Medical Center (US)
- Corresponding author
- Florman, Jeffrey Evan
- Venue
- Journal of Maine Medical Center
- Publisher
- Maine Medical Center
- Published
- 2020-07-01
- Volume
- 2
- Issue
- 2
- ISSN
- 2641-2225 (ISSN-L)
- OpenAlex
- W3038842942
- Cited by
- 0
- References
- 15
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Journal of Maine Medical Center (publishedVersion, cc-by)
- 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
- cognitive biases, diagnostic errors, neurosurgery, clinical reasoning, debiasing strategies, differential diagnosis, neurological symptoms, medical error reduction
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