Improving diagnosis: adding context to cognition

doi:10.1515/dx-2022-0058

. 2022 Aug 22;10(1):4-8.

doi: 10.1515/dx-2022-0058. eCollection 2023 Feb 1.

Improving diagnosis: adding context to cognition

Mark Linzer¹, Erin E Sullivan^{2

3}, Andrew P J Olson⁴, Maram Khazen^{2

5

6}, Maria Mirica⁵, Gordon D Schiff^{2

5}

Affiliations

¹ Department of Medicine and the Institute for Professional Worklife, Hennepin Healthcare and University of Minnesota Medical School, Minneapolis, MN, USA.
² Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA.
³ Sawyer School of Business, Suffolk University, Boston, MA, USA.
⁴ Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
⁵ Brigham and Women's Hospital, Center for Patient Safety Research, Boston, MA, USA.
⁶ School of Public Health, Haifa University, Haifa, Israel.

PMID: 35985033
DOI: 10.1515/dx-2022-0058

Free article

Improving diagnosis: adding context to cognition

Mark Linzer et al. Diagnosis (Berl). 2022.

Free article

. 2022 Aug 22;10(1):4-8.

doi: 10.1515/dx-2022-0058. eCollection 2023 Feb 1.

Authors

Mark Linzer¹, Erin E Sullivan^{2

3}, Andrew P J Olson⁴, Maram Khazen^{2

5

6}, Maria Mirica⁵, Gordon D Schiff^{2

5}

Affiliations

¹ Department of Medicine and the Institute for Professional Worklife, Hennepin Healthcare and University of Minnesota Medical School, Minneapolis, MN, USA.
² Harvard Medical School, Center for Primary Care, Harvard University, Boston, MA, USA.
³ Sawyer School of Business, Suffolk University, Boston, MA, USA.
⁴ Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
⁵ Brigham and Women's Hospital, Center for Patient Safety Research, Boston, MA, USA.
⁶ School of Public Health, Haifa University, Haifa, Israel.

PMID: 35985033
DOI: 10.1515/dx-2022-0058

Abstract

Background: The environment in which clinicians provide care and think about their patients is a crucial and undervalued component of the diagnostic process.

Content: In this paper, we propose a new conceptual model that links work conditions to clinician responses such as stress and burnout, which in turn impacts the quality of the diagnostic process and finally patient diagnostic outcomes. The mechanism for these interactions critically depends on the relationship between working memory (WM) and long-term memory (LTM), and ways WM and LTM interactions are affected by working conditions.

Summary: We propose a conceptual model to guide interventions to improve work conditions, clinician reactions and ultimately diagnostic process, accuracy and outcomes.

Outlook: Improving diagnosis can be accomplished if we are able to understand, measure and increase our knowledge of the context of care.

Keywords: diagnosis; physician burnout; work conditions.

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How does work environment relate to diagnostic quality? A prospective, mixed methods study in primary care.
Khazen M, Sullivan EE, Arabadjis S, Ramos J, Mirica M, Olson A, Linzer M, Schiff GD. Khazen M, et al. BMJ Open. 2023 May 5;13(5):e071241. doi: 10.1136/bmjopen-2022-071241. BMJ Open. 2023. PMID: 37147090 Free PMC article.

References

1. Sweller, J, Van Merrienboer, JJ, Paas, FG. Cognitive architecture and instructional design. Educ Psychol Rev 1998;10:251–96. https://doi.org/10.1023/A:1022193728205 .
1. Schiano, B. Reducing cognitive overload while teaching . Harvard Business Publishing. Available from: https://hbsp.harvard.edu/inspiring-minds/reducing-cognitive-overload-whi... .
1. Linzer, M, Manwell, LB, Williams, ES, Bobula, JA, Brown, RL, Varkey, AB, et al.. Working conditions in primary care: physician reactions and care quality. Ann Intern Med 2009;151:28–36. https://doi.org/10.7326/0003-4819-151-1-200907070-00006 . - DOI
1. Linzer, M, Gerrity, M, Douglas, J, McMurray, JE, Williams, ES, Konrad, TR. Physician stress: results from the physician worklife study. Stress Health 2002;18:37–42. https://doi.org/10.1002/smi.917 . - DOI
1. Croskerry, P. The rational diagnostician and achieving diagnostic excellence. JAMA 2022;327:317–8. https://doi.org/10.1001/jama.2021.24988 . - DOI

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[1] Sweller, J, Van Merrienboer, JJ, Paas, FG. Cognitive architecture and instructional design. Educ Psychol Rev 1998;10:251–96. https://doi.org/10.1023/A:1022193728205 .

[2] Sweller, J, Van Merrienboer, JJ, Paas, FG. Cognitive architecture and instructional design. Educ Psychol Rev 1998;10:251–96. https://doi.org/10.1023/A:1022193728205 .

[3] Schiano, B. Reducing cognitive overload while teaching . Harvard Business Publishing. Available from: https://hbsp.harvard.edu/inspiring-minds/reducing-cognitive-overload-whi... .

[4] Schiano, B. Reducing cognitive overload while teaching . Harvard Business Publishing. Available from: https://hbsp.harvard.edu/inspiring-minds/reducing-cognitive-overload-whi... .

[5] Linzer, M, Manwell, LB, Williams, ES, Bobula, JA, Brown, RL, Varkey, AB, et al.. Working conditions in primary care: physician reactions and care quality. Ann Intern Med 2009;151:28–36. https://doi.org/10.7326/0003-4819-151-1-200907070-00006 . - DOI

[6] Linzer, M, Manwell, LB, Williams, ES, Bobula, JA, Brown, RL, Varkey, AB, et al.. Working conditions in primary care: physician reactions and care quality. Ann Intern Med 2009;151:28–36. https://doi.org/10.7326/0003-4819-151-1-200907070-00006 . - DOI

[7] Linzer, M, Gerrity, M, Douglas, J, McMurray, JE, Williams, ES, Konrad, TR. Physician stress: results from the physician worklife study. Stress Health 2002;18:37–42. https://doi.org/10.1002/smi.917 . - DOI

[8] Linzer, M, Gerrity, M, Douglas, J, McMurray, JE, Williams, ES, Konrad, TR. Physician stress: results from the physician worklife study. Stress Health 2002;18:37–42. https://doi.org/10.1002/smi.917 . - DOI

[9] Croskerry, P. The rational diagnostician and achieving diagnostic excellence. JAMA 2022;327:317–8. https://doi.org/10.1001/jama.2021.24988 . - DOI

[10] Croskerry, P. The rational diagnostician and achieving diagnostic excellence. JAMA 2022;327:317–8. https://doi.org/10.1001/jama.2021.24988 . - DOI

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Improving diagnosis: adding context to cognition

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Improving diagnosis: adding context to cognition

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