Diagnostic error, overconfidence and self-knowledge

Abstract

According to the overconfidence hypothesis (OH), physician overconfidence is a major factor contributing to diagnostic error in medicine. This article argues that OH can be read as offering a personal, a sub-personal or a systemic explanation of diagnostic error. It is argued that personal level overconfidence is an “epistemic vice”. The hypothesis that diagnostic errors due to overconfidence can be remedied by increasing physician self-knowledge is shown to be questionable. Some epistemic vices or cognitive biases, including overconfidence, are “stealthy” in the sense that they obstruct their own detection. Even if the barriers to self-knowledge can be overcome, some problematic traits are so deeply entrenched that even well-informed and motivated individuals might be unable to correct them. One such trait is overconfidence. Alternative approaches to “debiasing” are considered and it is argued that overconfidence is blameworthy only if it is understood as a personal level epistemic vice rather than a sub-personal cognitive bias. This paper is published as part of a collection on self-knowledge in and outside of illness.