Clinician's Corner: Diagnostic errors

Every year, there are millions of medical diagnostic errors that result in a certain number of deaths.

Thinking an individual has disease X, when they have disease Y.

One way to minimize these errors was popularized in the book Thinking Fast and Slow, by Daniel Kahneman, which discusses System 1 and System 2 thinking.

System 1 thinking is fast.

It’s what people call a “snap decision.”

For example, if asked what 1 + 1 is, most people automatically blurt out “2” without consciously thinking about it.

System 2 thinking, on the other hand, is slow.

It’s analytical and takes more conscious effort.

If asked what 17 x 24 was, most people need a bit of time to get to the answer which is 408.

We fluidly switch back-and-forth from System 1 to System 2, and while they’re not two physically separate systems in the brain, they do represent a model that can help us to better understand the different ways that the brain operates.

When it comes to making a diagnosis, System 1 instantly kicks in when we recognize a pattern in a clinical presentation.

For example, let’s say a 35-year-old man with major depressive disorder, hypertension, and diabetes comes to a busy primary care clinic with worsening feelings of anxiety, rapid breathing, and occasional right-sided chest pain over the past 30 minutes.

He says, “It feels like the world is closing in on me.”

Some clinicians would make a fast, System 1 diagnosis that the patient is having a panic attack.