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Table 1 Classification of cognitive contributions to errors

From: Types of therapeutic errors in the management of osteoporosis made by physicians and medical students

Graber et al. [9]

Definition

Example

Tausendfreund et al.

Definition

Example

Type

Type

a. Faulty knowledge

a. Faulty knowledge

Knowledge base inadequate or defective

Insufficient Knowledge of relevant condition

Providers not aware of fournier gangrene

Lack of knowledge of a necessary therapeutic action

Clinician has insufficient knowledge of all therapeutic steps

Basis medication is incomplete or completely forgotten

Lack of knowledge of a special indication

Clinician has insufficient knowledge of a special indication for a specific therapeutic action

Patient with reoccurring vertebral body fractures receives alendronate (teriparatide would be indicated)

Lack of knowledge of contraindications

Clinician has insufficient knowledge of all contraindications

Patient with severe kidney failure is prescribed a bisphosphonate therapy

b. Faulty Synthesis: Faulty information processing

b. Faulty context generation and interpretation

Faulty context generation

Lack of awareness/consideration of aspects of patient’s situation that are relevant to diagnosis

Missed perforated ulcer in a patient presenting with chest pain and laboratory evidence of myocardial infarction

Misidentification of information as a contraindication

Clinician identifies given information as faulty as a contraindication

Wrong contraindications are stated (young age, certain medication, male sex)

   

Failure in recognizing contraindications

Clinician fails to identify information as a contraindication

Female patient with risk for thrombosis receives estrogen

Overestimating or underestimating usefulness or salience of a finding

Clinician is aware of symptom but either focuses too closely on it to the exclusion of others or fails to appreciate its relevance

Wrong diagnosis of sepsis in a patient with stable leukocytosis in the setting of myelodysplastic syndrome

Underestimation of a finding in the process of considering patients` individual risk

Deficiency in interpreting the patient’s individual 10-year -fracture-risk, leading to an underestimation

Advanced patient age or female sex is overlooked; the T-score is miscalculated

Faulty interpretation of results resulting in “undertreatment”

Clinician interprets given information as faulty, resulting in too little of an amount of therapy for the patient

post-menopausal condition is overlooked

Overestimation of a finding in the process of considering patients’ individual risks

Deficiency in interpreting the patient’s individual 10-year-fracture-risk, leading to an overestimation

BMI is misjudged; the T-score is miscalculated

Faulty interpretation of results resulting in “overtreatment”

Clinician interprets given information as faulty, resulting in too much of an amount of therapy for the patient

Fractures on non-osteoporosis relevant party of the body are included in risk calculation (e.g., rib, toe, …)

   

Failure to leave the common path of procedures

Clinician sticks to common therapy ignoring a special indication

In this case, the participant stated that ‘that the decision is based on personal experience’

c. Faulty synthesis: Faulty Verification

c. Faulty metacognition

Premature closure

Failure to consider other possibilities once an initial diagnosis has been reached

Wrong diagnosis of musculoskeletal pain after a car crash: ruptured spleen ultimately found

Possible overconfidence

Clinician fails to question their own findings

Necessary additional consult with a specialist is not performed (patient case with severe mastocytosis)

Failure to consult

Appropriate expert is not contacted

Hyponatremia inappropriately ascribed to diuretics in a patient later found to have lung cancer; no consultations requested

 

Lack of confidence

Clinician fails to trust their own findings

Additional consult with a specialist with a low threshold