It is important to recognize differences in the properties of the errors that may arise in all
three domains. Procedural errors are distinct, often visible, witnessed and recorded.19 This may
account for a disproportionately higher representation of these errors in retrospective, chart-based
studies of medical error. 22,23,24 Those who make procedural errors are often immediately
aware of doing so. In contrast, cognitive errors are generally less visible. Thinking is a largely
covert activity, and such errors are rarely witnessed or recorded. Cognitive errors are usually
evident only after the fact, and those who make them often have little awareness of them, even in
hindsight. The properties of emotional error make it especially difficult to deal with. As with
cognitive error, it is mostly covert, often not witnessed, and almost never recorded. Those who
make emotional errors usually appear unaware of them or their impact. Accordingly, it is difficult
to investigate them or quantify them, and emotional influences remain a blind spot both in studies
of clinical decision-making, and within the general context of patient safety.
It is important to recognize differences in the properties of the errors that may arise in all
three domains. Procedural errors are distinct, often visible, witnessed and recorded.19 This may
account for a disproportionately higher representation of these errors in retrospective, chart-based
studies of medical error. 22,23,24 Those who make procedural errors are often immediately
aware of doing so. In contrast, cognitive errors are generally less visible. Thinking is a largely
covert activity, and such errors are rarely witnessed or recorded. Cognitive errors are usually
evident only after the fact, and those who make them often have little awareness of them, even in
hindsight. The properties of emotional error make it especially difficult to deal with. As with
cognitive error, it is mostly covert, often not witnessed, and almost never recorded. Those who
make emotional errors usually appear unaware of them or their impact. Accordingly, it is difficult
to investigate them or quantify them, and emotional influences remain a blind spot both in studies
of clinical decision-making, and within the general context of patient safety.
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