A Proposed Systematic Approach to the Cognitive Autopsy for Internists.

Kathryn E Berlin,Kathlyn E Fletcher

doi:10.7759/cureus.20965

Abstract

The cognitive autopsy has been a proposed tool for physicians to evaluate misdiagnosis. However, prior iterations of this tool are cumbersome, not designed for the internist, and may cause users to isolate cognition from systems issues. A 10-point tool was created to be utilized individually or by a group when evaluating an adverse event. This could be used with Croskerry’s 2020 “cognitive autopsy” or as a standalone tool for internists. We trialed this tool in large group formats and with individual residents; all reported an improved appreciation of the factors leading to poor outcomes and medical errors.

Highlights

An autopsy is defined as “an examination of a body after death to determine the cause of death or the character and extent of changes produced by disease” [1]
Diagnostic errors may span days to weeks, with multiple players involved requiring a more organized format; The affective and cognitive dispositions outlined in this methodology do not break down the thought process involved with diagnostic cognition as systematically as possible
Many residents reported a greater understanding of the complex dynamics at play in medical errors and appreciated the analytic approach to cognitive errors

Summary

Introduction

An autopsy is defined as “an examination of a body after death to determine the cause of death or the character and extent of changes produced by disease” [1]. Diagnostic errors may span days to weeks, with multiple players involved requiring a more organized format; The affective and cognitive dispositions outlined in this methodology do not break down the thought process involved with diagnostic cognition as systematically as possible It can be cumbersome and downright difficult to determine which dispositions were involved in misdiagnosis on initial use; Because of the multifactorial nature of medical errors, it is essential to have a systematic evaluation method. The goal was to create a cognitive autopsy tool that is systematic yet manageable and would allow physicians, including trainees, to perform a retrospective analysis of diagnostic errors in a beneficial manner This tool needed to encompass both systems issues and cognitive errors and could be utilized by individuals or groups during an educational conference such as Morbidity & Mortality. This is essential because an appropriate solution requires addressing failure to obtain, interpret, synthesize, or rescue and the underlying cognitive biases

Discussion

Disclosures

Croskerry P