Episode 11: Cognitive Decision Making and Medical Error

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 4 February 2011

⏱️ 97 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

In this episode on Cognitive Decision Making & Medical Error, Dr. Doug Sinclair, CMO of St. Michael's Hospital and Dr. Chris Hicks show us that, while the ED physician's knowledge base may play a small part in predicting medical error, more important might be how we understand and reflect upon our decision-making processes, how we communicate with our staff and patients, and how we cope with the ED environment and shift work. Medical error is the 6th leading cause of death in North America, and despite huge advances in imaging technology and lab testing as well as an explosion of EM literature in recent years, the misdiagnosis rate detected through autopsy studies has not changed significantly over the past century. Studies on diagnostic error in emergency medicine have shown error rates between 1 and 12%, and it's been suggested that cognitive error, or some flaw in the decision making process (as apposed to a lack of knowledge), is present in about 95% of these cases. Dr. Sinclair and Dr. Hicks elucidate for us how to identify and understand cognitive decision making and medical error, and how we can improve our decision making, reduce medical error and optimize the care of our patients.

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com.
0:07.6	I'm your host, Dr. Anton Helman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:18.1	On this episode number 11 on diagnostic decision-making and medical error, we have with us Dr. Doug Sinclair and Dr. Chris Hicks.
0:26.9	Dr. Doug Sinclair is an emergency physician and administrator with a special interest in patient safety and medical error.
0:32.4	He is currently EVP and chief medical officer at St. Michael's Hospital in Toronto.
0:37.4	He worked in Nova Scotia for 22 years where he held a number of positions,
0:40.6	including first deputy chair of EM at Delhousie University,
0:44.2	chief of EM at Capital Health, the IWK Health Center,
0:48.1	and Associate Dean of CME at Dalhousie University.
0:51.5	Dr. Chris Hicks is an emergency physician at St. Michael's Hospital in Toronto.
0:55.6	In addition to his FRCP EM training, he completed a master's of education at the University of
1:00.6	Toronto. I know. You're probably thinking, diagnostic decision-making and medical error sounds
1:07.3	like some flaky, pseudosychologic babble or something. You're thinking, I want to hear
1:12.8	some cutting edge clinical pearls on resuscitation and MI and GI bleeds and stuff like that.
1:18.9	Well, if this is your reaction, just hear me out. If you take what you learn in this episode and
1:24.5	apply it to your daily practice. It'll probably be this episode
1:29.0	that is the most likely to improve your patient's outcomes. You see, most of us have a solid knowledge
1:35.1	base and know what to do in the vast majority of clinical situations. The factors that lead to
1:39.9	medical error often have more to do with communication, the emergency environment, our mood,
1:45.3	how well rested we are, and how we reflect on our decisions, rather than what specific
1:49.7	information we know about a particular emergency subject. Medical error is the sixth leading
1:55.9	cause of death in North America, and despite huge advances in imaging technology and lab testing, as well as an
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