PhD defence J. (Justine) Staal

Below is a brief summary about the dissertation:

Diagnostic errors are a major threat to patient safety, as most patients are thought to encounter at least one diagnostic error during their lifetime – sometimes with devastating consequences. Although diagnostic errors have been accepted as an important topic in the last decade, many questions still remain regarding the origins of diagnostic errors and how they are best prevented. To contribute to this topic, this thesis examines the diagnostic reasoning process of clinicians in both erroneous and correct diagnoses, to gain insight in the underlying processes. I aim to provide further insight in the cognitive mechanisms underlying diagnostic errors and possible error interventions. 

Based on the studies in this thesis, we conclude that neither differences in cognitive processes nor the type of information used during diagnosis are related to
diagnostic errors. Instead, the results support the hypothesis that clinicians’ available mindware (i.e., the relevant knowledge they have access to on a specific subject) and the
degree of mindware instantiation (i.e., how automated and easily accessible this knowledge is) determine whether a correct diagnosis can be made. We further demonstrated that
cognitive reasoning tools were effective in improving diagnostic accuracy, via interventions that improve clinicians’ mindware, either by targeting individual’s relevant knowledge or by providing external mindware through systems such as the electronic health record. 

In conclusion, cognitive causes of diagnostic errors are an important part of the problem and can be reduced, but the full context of clinical practice needs to be considered to effectively reduce diagnostic errors as a whole.