Exploring the sources and mechanisms of cognitive errors in medical diagnosis with associative memory models.

BACKGROUND: One of the central challenges of third millennium medicine is the abatement of medical errors. Among the most frequent and hardiest causes of misdiagnosis are cognitive errors produced by faulty medical reasoning. These errors have been analyzed from the perspectives of cognitive psychology and empirical medical studies. We introduce a neurocognitive model of medical diagnosis to address this issue.

METHODS: We construct a connectionist model based on the associative nature of human memory to explore the non-analytical, pattern-recognition mode of diagnosis. A context-dependent matrix memory associates signs and symptoms with their corresponding diseases. The weights of these associations depend on the frequencies of occurrence of each disease and on the different combinations of signs and symptoms of each presentation of that disease. The system receives signs and symptoms and by a second input, the degree of diagnostic uncertainty. Its output is a probabilistic map on the set of possible diseases.

RESULTS: The model reproduces different kinds of well-known cognitive errors in diagnosis. Errors in the model come from two sources. One, dependent on the knowledge stored in memory, varies with the accumulated experience of the physician and explains age-dependent errors and effects such as epidemiological masking. The other is independent of experience and explains contextual effects such as anchoring.

CONCLUSIONS: Our results strongly suggest that cognitive biases are inevitable consequences of associative storage and recall. We found that this model provides valuable insight into the mechanisms of cognitive error and we hope it will prove useful in medical education.