Cognitive errors in anesthesiology, as in other medical specialties, are rooted in the low-visibility, elusive cognitive landscape of hardwired thinking processes. Various forms of bias, heuristics, non-rational thought preferences, and other factors contribute to cognitive errors in anesthesiology. Today, at the Carolina Refresher Course in Asheville, I gave a talk entitled “Psychology of Decision Making: Cognitive Errors in Anesthesiology” in which I touched on some of these factors. In the coming months, I will have several new papers published that summarize my current thinking and recent research on theses ideas, and in the meantime, I’m doing my best to avoid self-plagarizing. People seem to really enjoy learning more about this topic, but I can’t give it all away on the blog! Clearly, this paradigm is important for patient safety and the reduction of medical errors, as we know that thinking errors (not factual errors or procedural errors) are the key cause of up to 80% of medical mistakes.

As is often the case when I give a lecture or workshop on cognitive error in medicine, folks approach me afterwards and share stories with me. Usually it is the case of something gone wrong, but today an older doc told me a quick anecdote from his surgical internship that he says was very formative for him. He was presenting a complex patient to a very senior surgeon, who listened thoughtfully to the narrative, then paused and said “I’m not sure I understand everything I know about what you are telling me.” Consider those words carefully. “I’m not sure I understand everything I know…” I can’t ask for clarification from this senior surgeon, who is almost certainly no longer living based on the ages and timeline of the story, but this man clearly wasn’t afraid to have some vulnerability and uncertainty in the face of complexity, despite everything he does indeed know after years and years of developing surgical expertise. Surely this is better than the modern motto “Often wrong, but never in doubt!” Embracing a healthy skepticism for our own limits is one way to bolster patient safety and prevent cognitive errors in anesthesiology (or cognitive errors in medicine of any domain), by avoiding premature closure, anchoring, availability bias, and others.

I’m going to practice saying this to myself and to my trainees more often. I’m not sure I understand everything I know about this situation… Go ahead, try it!

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