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Pivot and cluster strategy: a preventive measure against diagnostic errors

Authors Shimizu T, Tokuda Y

Received 4 October 2012

Accepted for publication 16 October 2012

Published 6 November 2012 Volume 2012:5 Pages 917—921

DOI https://doi.org/10.2147/IJGM.S38805

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Taro Shimizu,1 Yasuharu Tokuda2

1Rollins School of Public Health, Emory University, Atlanta, GA, USA; 2Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan

Abstract: Diagnostic errors constitute a substantial portion of preventable medical errors. The accumulation of evidence shows that most errors result from one or more cognitive biases and a variety of debiasing strategies have been introduced. In this article, we introduce a new diagnostic strategy, the pivot and cluster strategy (PCS), encompassing both of the two mental processes in making diagnosis referred to as the intuitive process (System 1) and analytical process (System 2) in one strategy. With PCS, physicians can recall a set of most likely differential diagnoses (System 2) of an initial diagnosis made by the physicians’ intuitive process (System 1), thereby enabling physicians to double check their diagnosis with two consecutive diagnostic processes. PCS is expected to reduce cognitive errors and enhance their diagnostic accuracy and validity, thereby realizing better patient outcomes and cost- and time-effective health care management.

Keywords: diagnosis, diagnostic errors, debiasing

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