Approaches to clinical problem solving

At a glance

• Diagnosis is a process of gathering information, generating hypotheses, testing them and revising. Most errors come from a mix of system factors (handover, access, test follow-up) and cognitive factors.
• Graber 2005 reviewed 100 diagnostic errors in internal medicine: cognitive factors in 74%, system factors in 65%. Premature closure was the single commonest cognitive error. Faulty knowledge was rare; faulty synthesis was the usual problem.
• The US burden study (Newman-Toker 2024) estimated about 795,000 deaths or permanent disabilities a year from diagnostic error, concentrated in vascular events, infections and cancers.