A Primer on Cognitive Errors Illustrated Through the Lens of a Neurosurgical Practice

Abstract

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.