Ian Presnell; Week 1 MED1022, Clinical Skills (Monash University)
Potential error 1: incomplete pattern, making assumptions based on a pattern from the picture that may not be correct.
Potential error 2: premature closure, coming to a conclusion based on insufficient or incomplete information.
Potential error 3: anecdotal knowledge, inferring knowledge from appearance
Potential error 4: attribution error, attributing an unrelated problem to a condition (usually stigmatising).
Potential error 5: availability error, using available experience or knowledge that is not directly related to the patient being considered. Available knowledge is knowledge as a result of training. Anecdotal knowledge is generally case based.
Potential error 6: commission bias, that is the need to do something even when it may not be necessary.
Potential error 7: diagnostic momentum, related to premature closure in that it is fitting or interpreting informaiton to fit a diagnosis.
Potential error 9: halo effect, related to attribution error, having different (positive) expectations of a patient on the basis of some unrelated personal characteristic as opposed to an illness.
Potential error 10: positive and negative countertransferance, how you feel towards a patient (transferance is how they feel towards you)
Experienced doctors (Dreyfuss' experts) use sophisticated pattern recognition, non experts use hypothesis testing. Errors are potential and not mutually exclusive. A novice memorises lists, applies rules with basic features, ignores context and sees each case in isolation. Advanced beginner sees common aspects of situations and develops maxims, begins to consider context, makes connections from other experiences to current situation. Competent prioritises data, plans approach to patient situation, develops emotional attachment to task. Proficient scrolls through list of possibilities efficiently. Can recognise unsolved problem and manages distractions. Experts have vast prior knowledge to draw from, moves quickly and intuitively to identify problem, has strategies for when rules don't apply.