Feature Article| Volume 16, ISSUE 8, P582-585, September 2020

The Practice of Medicine: Understanding Diagnostic Error


      • Clinical decision making is complex and involves many cognitive reasoning processes.
      • Identifying cognitive decision processes and biases increase accuracy during clinical diagnosis formation.
      • Supportive strategies including both clinician and health-care system improvements can reduce diagnostic errors.


      The medical community abides by oaths and expectations as they care for patients, with the general consensus of “do no harm” to the patient. One of the most feared acts is a medical error that could have been avoided. Included in medical errors are diagnostic errors, which can occur in all areas of medicine. Understanding our decision-making process can improve our diagnostic skills and identify any influences leading to an error. This article will provide nurse practitioners with ways to become more self-aware with every patient encounter and improve their understanding of diagnostic error.


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        • Institute of Medicine (US)
        Committee on Quality of Health Care in America.
        in: Kohn L.T. Corrigan J.M. Donaldson M.S. To Err is Human: Building a Safer Health System. National Academy Press, Institute of Medicine, 1999
        • Makary M.A.
        • Daniel M.
        Medical error—the third leading cause of death in the US.
        BMJ. 2016; 353: i2139
        • Kavanagh K.T.
        • Saman D.M.
        • Bartel R.
        • Westerman K.
        Estimating hospital-related deaths due to medical error: a perspective from patient advocates.
        J Patient Saf. 2017; 13: 1-5
        • Iyer S.
        • Goss E.
        • Browder C.
        • Paccione G.
        • Arnsten J.
        Development and evaluation of a clinical reasoning curriculum as part of an internal medicine residency program.
        Diagnosis. 2019; 6: 115-119
        • Leape L.L.
        Counting deaths due to medical errors.
        JAMA. 2002; 288: 2404-2405
        • Nendaz M.
        • Perrier A.
        Diagnostic errors and flaws in clinical reasoning: mechanisms and prevention in practice.
        Swiss Med Wkly. 2012; 142: w13706
        • Society to Improve Diagnosis in Medicine
        What is Diagnostic Error? 2020.
        (Accessed April 10, 2020)
        • Singh H.
        • Schiff G.
        • Graber M.
        • Onakpoua I.
        • Thompson M.
        The global burden of diagnostic errors in primary care.
        BMJ Qual Saf. 2017; 26: 484-494
        • Klocko D.J.
        Are cognitive biases influencing your clinical decisions?.
        Clinician Rev. 2016; 26: 32-39
        • Croskerry P.
        Achieving quality in clinical decision making: cognitive strategies and detection of bias.
        Acad Emerg Med. 2002; 9: 1184-1203
        • Shin H.S.
        Reasoning processes in clinical reasoning: from the perspective of cognitive psychology.
        Korean J Med Educ. 2019; 31: 299-308
        • Bate L.
        • Hutchinson A.
        • Underhill J.
        • Maskrey N.
        How clinical decisions are made.
        Br J Clin Pharmacol. 2012; 74: 614-620
        • Smythe O.
        • McCabe C.
        Think and think again! Clinical decision making by advanced nurse practitioners in the emergency department.
        Int Emerg Nurs. 2017; 31: 72-74
        • LaManna J.
        • Guido-Sanz F.
        • Anderson M.
        • et al.
        Teaching diagnostic reasoning to advanced practice nurses: positives and negatives.
        Clin Simul Nurs. 2019; 26: 24-31
      1. Stephens TM. Cognitive debiasing: learning to “change your mind.” Nurse Lead. Published online October 3, 2019.

        • Croskerry P.
        • Singhal G.
        • Mamede S.
        Cognitive debiasing 1: origins of bias and theory of debiasing.
        BMJ Qual Saf. 2013; 22: ii58-ii64
        • Carver N.
        • Gupta V.
        • Hipskind J.E.
        Medical Error. NCBI Bookshelf: StatPearls; 2020.
        (Accessed April 11, 2020)
        • World Health Organization
        Diagnostic Errors: Technical Series of Safer Primary Care. 2016.
        (Accessed April 11, 2020)
        • Sweeny C.F.
        • LeMahieu A.
        • Fyer G.
        Nurse practitioner malpractice data: informing nursing education.
        J Prof Nurs. 2017; 33: 271-275
        • Delacroix R.
        Exploring the experience of nurse practitioners who have committed medical errors: a phenomenological approach.
        J Am Acad Nurse Pract. 2017; 29: 403-409


      Christina Cantey, MSN, FNP-C, is a nurse practitioner at McMillon Medical Group, Huntsville, Alabama, and can be contacted at [email protected]