• Shyam Murali

Medical Errors - Dave Johnson, MD

Dr. Dave Johnson, our department's Medical Director, gives regular lectures on patient experience and satisfaction, evidence-based clinical practice, and updates on departmental policies and procedures. Recently, he gave a lecture about medical errors and ways to overcome them. How do you prevent medical errors in your emergency department?


We need to get better at avoiding:

o Delayed or inaccurate diagnoses

o Delayed or inappropriate treatments

Causes of bias:

o Fatigue

o Chaos

o Incomplete data/information

o Interruptions

Why is it hard to de-bias?

o Unaware of bias occurring

o Overconfident

o Unappealing

o Bias against bias


Some examples of bias in the ED:

– Premature closure

  • Tendency to accept the diagnosis before it has been fully verified, stopping the decision-making process.

– Anchoring

  • Tendency to perceptually lock onto salient features in the patient’s initial presentation too early in the diagnostic process and failing to adjust initial impression in the light of later information

– Diagnostic momentum

  • Through intermediaries (patients, paramedics, nurses, physicians), what might have started as a possibility gathers increasing momentum until it becomes definite, and all other possibilities are excluded

  • Take a step back and think objectively about the patient

– Confirmation bias

  • Tendency to look for confirming evidence to support a diagnosis rather than look for disconfirming evidence to refute it

  • Disconfirming evidence is often more persuasive and definitive

– Availability bias

  • Disposition to judge things as being more likely, or frequently occurring, if they readily come to mind

  • Recent experience with a disease may inflate the likelihood of its being diagnosed; conversely, not seeing a disease for a long time, may cause it to be diagnosed less frequently

– Framing effect

  • How diagnosticians see things may be strongly influenced by the way in which the problem is framed

  • Ex. Framing patient complaints in fast track (“Because they’re in fast track, there must not be anything serious going on with their back pain”)


Reducing cognitive errors:

– Be AWARE

  • Acknowledge we make mistakes

  • Wisdom – education, learning

  • Ambiance – ED design, less interruption

  • Rules – forcing functions (sit down, consider opposites)

  • ED team empowerment


Find ways to reset your mind when you catch yourself falling into a bias trap.

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