Approach to ... Building A Cognitive Shield Against Emergency Misdiagnosis
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Diagnostic error represents the most significant, yet historically overlooked, threat to patient safety in contemporary medicine. In the high-velocity, information-scarce environment of the emergency department (ED), the stakes of clinical decision-making are uniquely amplified. Recent evidence suggests that approximately 5.7% of all emergency department patients—equivalent to one in 18—receive an incorrect diagnosis, a figure that translates into 7.4 million misdiagnoses annually in the United States alone.[1, 2] The human cost of these failures is staggering, with an estimated 2 million patients suffering misdiagnosis-related harms and 350,000 experiencing permanent disability or death.[2] This report synthesizes foundational diagnostic reasoning principles with the latest literature from 2023 through 2025 to provide a practical, evidence-based guide for emergency clinicians. By integrating the optimized problem representation method with the SPOT Dx framework, clinicians can cognitively force systematic reasoning to mitigate the inherent vulnerabilities of emergency practice.
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