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 |