Question
When are mistakes in clinical practice most likely to happen, and what strategies can help reduce these errors?
Answer
When do mistakes happen? Research indicates that the most common errors occur during unfamiliar circumstances or when we're short on time and feeling rushed. It would be ideal if all our situations were familiar and we never felt pressed for time—problem solved, right? However, the reality is quite the opposite. Our daily routines are filled with unfamiliar circumstances, surprises, complex patients, and conditions we may not fully understand. This is not just in speech pathology but in healthcare in general. It is rare to encounter a patient who knows exactly what to do. The human body is one of the most complex entities in the known universe.
Medical care is inherently complex, and mistakes are inevitable. Recognizing this, it is important to be aware of situations where errors are more likely. For instance, if you are working on a PRN basis, moving between different facilities, or managing a caseload of 12 patients with a tight schedule, these are times when you are more prone to errors. Being mindful of these circumstances allows you to take proactive steps—such as seeking assistance or adjusting your workload—to mitigate potential mistakes.
Let's take a moment to reflect on our thinking processes—a metacognitive exercise if you will. In Thinking, Fast and Slow, psychologist Daniel Kahneman describes two modes of thought: System 1 and System 2.
System 1 is fast, automatic, and intuitive. It operates with little to no effort and often relies on heuristics—mental shortcuts that allow us to make quick judgments. For example, when deciding what to eat or wear in the morning, or when driving a familiar route, we're engaging System 1 thinking. This system is efficient for routine decisions but can lead to errors when applied to complex situations.
System 2, on the other hand, is slow, deliberate, and analytical. It is activated when we encounter novel situations or complex problems that require careful consideration. For instance, solving a complex math problem, planning a detailed project, or making significant life decisions like buying a home involves System 2 thinking. This system requires more cognitive resources and is less prone to biases, making it more suitable for complex decision-making.
In the context of healthcare, both systems play crucial roles. Experienced clinicians often rely on System 1 thinking to make quick decisions based on pattern recognition and experience—a process sometimes referred to as "intuition." However, this can lead to cognitive biases if not checked. For example, a clinician might diagnose a common condition based on initial symptoms without considering less common alternatives—a bias known as "anchoring."
Conversely, System 2 thinking is essential when dealing with complex or unfamiliar cases. It allows clinicians to methodically analyze patient information, consider differential diagnoses, and weigh the risks and benefits of various treatment options. Engaging System 2 reduces the likelihood of diagnostic errors and enhances patient care.
Understanding when to engage each system is vital. While System 1 allows for efficiency, especially in high-pressure environments, it is important to recognize situations that require the more deliberate approach of System 2. By being mindful of our cognitive processes, we can improve our decision-making and provide better outcomes for our patients.
This Ask the Expert is an edited excerpt from the course, Medically Complex Decision-Making for the SLP, presented by George Barnes, MS, CCC-SLP.
