Skip to main content

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