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Editorial on ‘Assessing the association between thinking dispositions and clinical error’
  1. Philip D Welsby
  1. Correspondence to Dr Philip D Welsby, 1 Burnbrae, Edinburgh EH12 8UB, UK; Philipwelsby{at}aol.com

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Thinking that you might be wrong 

The paper ‘Assessing the association between thinking dispositions and clinical error’ reminds us of our potential fallibilities.1 

The authors use a simple and simplistic task to determine Type 1 thinking preference (drug A+drug B=110 mg. Drug A is 100 mg more than drug B. What are doses of each?). i The results of these tests were compared with self-reported instances of clinical error. Only 59% of 153 clinicians reported making a clinical error in the previous 3 months. The conclusion, given several caveats, was that there was not a significant relationship between Type 1 thinking and the propensity to make clinical errors. The numbers studied were small and the test conditions were not specified.

Correct clinical decisions entail more than correct thinking. Problems have to be perceived correctly and there should be reflection with feedback.

Perceptions may be fallible

Perceptions may be fallible.2 There are three eye problems. (1) We wrongly assume we observe everything within our visual fields as if it were a detailed photograph, (2) efferent optic nerve fibres (20%) may programme the retina to influence what it informs our brains and (3) we are unaware of our blind spots. There are seven brain problems. (1) Our brains often misinterpret information presented to them, (2) occurrences seen by our non-dominant eye may be relatively neglected, (3) unexpected images (presumably those that a clinician should be particularly interested in) may be suppressed,ii (4) brains ignore substantial changes in scenarios,iii (5) we overestimate our multitasking skills, (6) our knowledge of what is normal may be limited and (7) people who are incompetent are often unaware of their incompetence as part of their incompetence—the Dunning Kruger effect.3

Thinking may be fallible

Type 1 …

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