© 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in...
-
Upload
philippa-underwood -
Category
Documents
-
view
238 -
download
3
Transcript of © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in...
![Page 1: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/1.jpg)
© 2006 Wotkyns Creative
Dennis J. Boyle, MDDenver Health/UCDSOMCOPIC2014
Cognitive Error in MedicineThinking like Sherlock
![Page 2: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/2.jpg)
2
Outline
Scope of the problem
How we diagnose
Examples
Improving the process
3
1
2
4
![Page 3: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/3.jpg)
The diagnosis is every doctor's measure of his own abilities and is the most important ingredient of his self-image
Nuland 1994
3
![Page 4: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/4.jpg)
The death of one man is a tragedy The death of millions is a statistic Stalin
4
![Page 5: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/5.jpg)
The death of one man is a tragedy The death of millions is a statistic Stalin
5
![Page 6: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/6.jpg)
80,000 deaths a year
Leape JAMA 2002
6
![Page 7: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/7.jpg)
So what is a diagnostic error?
7
![Page 8: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/8.jpg)
What is a diagnostic error?
A missed or delayed opportunity to make a timely diagnosis
Singh JAMA IM 2013
8
![Page 9: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/9.jpg)
Diagnostic error is divided into cognitive and systems. Today we will look at cognitive…
9
![Page 10: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/10.jpg)
Cognitive error is different
10
![Page 11: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/11.jpg)
Cognitive error is complex…
Evolving/NYD
11
![Page 12: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/12.jpg)
Evolving/NYD
Pt issues
12
Complex…
![Page 13: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/13.jpg)
Evolving/NYD
Pt issues
System issues
13
Complex…
![Page 14: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/14.jpg)
Evolving/NYD
Pt issues
System issues
14
Complex…
![Page 15: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/15.jpg)
Evolving/NYD
Pt issues
System issues
WHO 12,420 diseases
15
Complex…
![Page 16: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/16.jpg)
Error rate
80% of charts no diff DX
54% feel they make one error/month
Rad/Path rate 2%
IM rate 10 – 15%
1/1000 outpatient visits
Singh 2013 Graber Am Jmed 2008 Arthur Elstein
16
![Page 17: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/17.jpg)
Error results in……
#1 cause of lawsuits
Overtreatment
Emotional impact
Wasted money and time
Gelhart NEJM 2009
17
![Page 18: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/18.jpg)
Can we afford to be perfect- breast imaging
18
![Page 19: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/19.jpg)
And cognitive errors occur because….
19
![Page 20: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/20.jpg)
But it’s still complicated…..A stroke alert story
20
![Page 21: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/21.jpg)
But it’s still complicated…..A stroke alert story
21
![Page 22: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/22.jpg)
22
How we think - System I vs. System II
Kahneman and Tvertsky
![Page 23: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/23.jpg)
23
How we think - System I vs. System II
Kahneman and Tvertsky
![Page 24: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/24.jpg)
24
How we think - System I vs. System II
Kahneman and Tvertsky
![Page 25: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/25.jpg)
25
Where does this all happen?
Lehrer J How we decide. 2009
![Page 26: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/26.jpg)
26
![Page 27: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/27.jpg)
Thin slicing - Separating wheat and chaff
27
![Page 28: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/28.jpg)
Blink
28
Where is the lesion?
![Page 29: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/29.jpg)
Blink
29
![Page 30: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/30.jpg)
Blink
30
Where was the lesion?
![Page 31: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/31.jpg)
System I - Blink
31
![Page 32: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/32.jpg)
System II - Hypothetico-deductive style
Rigorous
List all possibilities
Probabilistic
Occurs in prefrontal cortex
32
![Page 33: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/33.jpg)
System II- Hypothetico-deductive style
Problem list
Lower GI symptoms
Arthralgias
High ESR
Low vitamin D
Low back pain
Osteoporosis
J Hirsh 2011
Differential DX
Sprue
Reactive arthritis
Colitis w Spondy
Vasculitis-PAN
Fibromyalgia/ IBS w another cause of ESR
33
![Page 34: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/34.jpg)
![Page 35: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/35.jpg)
How much time do you spend in system I
20%
50%
75%
95%
35
![Page 36: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/36.jpg)
How much time do you spend in system I
95%
36
![Page 37: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/37.jpg)
The brain is a cognitive miser
37
![Page 38: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/38.jpg)
Toggle function system I and II
38
![Page 39: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/39.jpg)
Stress and fatigue push us to system I
39
![Page 40: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/40.jpg)
The problem with System I is biases – name the bias
40
![Page 41: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/41.jpg)
41
![Page 42: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/42.jpg)
42
Anchoring bias - rely on first impressionPremature closure – decide too early
![Page 43: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/43.jpg)
43
Last 2 patients had flu - Availability bias – what comes to mind
![Page 44: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/44.jpg)
44
![Page 45: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/45.jpg)
Affection bias – taking care of loved ones Evolving - NYD
45
![Page 46: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/46.jpg)
Framing bias – how it’s presented
46
I’ve got this pt I’d like you to see.
She’s a psych patient with CP…..
He’s a drunk with abdominal pain
Mcneil NEJM 1982
![Page 47: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/47.jpg)
Fast track patient with a cold
47
![Page 48: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/48.jpg)
48
![Page 49: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/49.jpg)
Anchoring and framing biases
49
![Page 50: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/50.jpg)
At sign out knee trauma F/U US
50
![Page 51: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/51.jpg)
Framing and premature closure
51
![Page 52: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/52.jpg)
Where is the lesion?
52
9
![Page 53: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/53.jpg)
Search satisficing - Stop the diagnostic process once one diagnosis has been made-
53
9
![Page 54: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/54.jpg)
December 2000
![Page 55: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/55.jpg)
Ten Years Later
![Page 56: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/56.jpg)
Ten Years Later
Alliteration bias – previous errors
![Page 57: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/57.jpg)
57
Anchoring bias is the big kahuna……
![Page 58: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/58.jpg)
Top 10 fixes for diagnostic errors
58
![Page 59: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/59.jpg)
#10 Reflective listening and build a story
59
![Page 60: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/60.jpg)
#10 75% of the DX comes from the HX
60
![Page 61: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/61.jpg)
#9 Mindfulness - reflective practice
61
![Page 62: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/62.jpg)
#8 Build your knowledge base
62
![Page 63: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/63.jpg)
#8 And try to figure it out
63
![Page 64: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/64.jpg)
#7 Always do a differential
Problem list
Lower GI symptoms
Arthralgias
High ESR
Low vitamin D
Low back pain
Osteoporosis
J Hirsh 2011
Differential DX
Sprue
Reactive arthritis
Colitis w Spondy
Vasculitis-PAN
Fibromyalgia/ IBS w another cause of ESR
64
![Page 65: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/65.jpg)
#6 Use your Bayes A 63 YO w CP and DM ? treadmill
65
![Page 66: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/66.jpg)
#5 Use Occams razor
66
![Page 67: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/67.jpg)
#4 IT –the original tricorder…think Amazon...
67
![Page 68: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/68.jpg)
68
![Page 69: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/69.jpg)
18 hour w/o sleep = ETOH 0.05%
And when you’re behind, tired or overloaded….
Beer pic
#3- Be aware of stress
![Page 70: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/70.jpg)
#2 – Always ask what else could this be?
70
![Page 71: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/71.jpg)
#1 Think like Sherlock
Sherlock clip
Manede Psych res 2010
71
![Page 72: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/72.jpg)
So what do I do?
If you’re sure
What else could it be ?
If You’re not - NYD
72
![Page 73: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/73.jpg)
So what do I do?
If you’re sure
If You’re not - NYD
S
O
A
P
Think like Sherlock!
73
![Page 74: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/74.jpg)
Homework for all of us!!!
If you’re sure
What else could it be ?
If You’re not - NYD
S
O
A
P
Think like Sherlock!
74
![Page 75: © 2006 Wotkyns Creative Dennis J. Boyle, MD Denver Health/UCDSOM COPIC 2014 Cognitive Error in Medicine Thinking like Sherlock.](https://reader035.fdocuments.in/reader035/viewer/2022081722/56649f155503460f94c2b3e2/html5/thumbnails/75.jpg)
75
The problem is not knowledge but thinking. Can improve your diagnosing?
Dennis Boyle [email protected]
Please fill out thefeedback form
The rubber hits the road
1 ERS point