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Diagnostic errors and reflective practice in medicine

Authors

  • Sílvia Mamede MD MPH,

    Corresponding author
    1. President, Innovare Institute, Fortaleza, Brazil; Center of Educational Development, Medical School, Federal University of Ceará, Fortaleza, Brazil
      Sílvia Mamede
      Avenue Alvaro Correia, 455, 802/A
      CEP: 60165-230
      Fortaleza
      Ceará
      Brazil
      E-mail: silviamamede@uol.com.br
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  • Henk G. Schmidt PhD,

    1. Dean, Department of Psychology, Faculty of Social Sciences, Erasmus University, Rotterdam, The Netherlands
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  • Remy Rikers PhD

    1. Associate Professor, Department of Psychology, Faculty of Social Sciences, Erasmus University, Rotterdam, The Netherlands
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Sílvia Mamede
Avenue Alvaro Correia, 455, 802/A
CEP: 60165-230
Fortaleza
Ceará
Brazil
E-mail: silviamamede@uol.com.br

Abstract

Background  Adverse effects of medical errors have received increasing attention. Diagnostic errors account for a substantial fraction of all medical errors, and strategies for their prevention have been explored. A crucial requirement for that is better understanding of origins of medical errors. Research on medical expertise may contribute to that as far as it explains reasoning processes involved in clinical judgements. The literature has indicated the capability of critically reflecting upon one’s own practice as a key requirement for developing and maintaining medical expertise throughout life.

Objectives  This article explores potential relationships between reflective practice and diagnostic errors.

Methods  A survey of the medical expertise literature was canducted. Origins of medical errors frequently reported in the literature were explored. The potential relationship between diagnostic errors and the several dimensions of reflective practice in medicine, brought to light by recent research, were theoretically explored.

Results and Dissussion  Uncertainty and fallibility inherent to clinical judgements are discussed. Stages in the diagnostic reasoning process where errors could occur and their potential sources are highlighted, including the role of medical heuristics and biases. The authors discuss the nature of reflective practice in medicine, and explore whether and how the several behaviours and reasoning processes that constitute reflective practice could minimize diagnostic errors. Future directions for further research are discussed. They involve empirical research on the role of reflective practice in improving clinical reasoning and the development of educational strategies to enhancing reflective practice.

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