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Abstract
The great majority of medical diagnoses are made using automatic, efficient cognitive
processes, and these diagnoses are correct most of the time. This analytic review
concerns the exceptions: the times when these cognitive processes fail and the final
diagnosis is missed or wrong. We argue that physicians in general underappreciate
the likelihood that their diagnoses are wrong and that this tendency to overconfidence
is related to both intrinsic and systemically reinforced factors. We present a comprehensive
review of the available literature and current thinking related to these issues. The
review covers the incidence and impact of diagnostic error, data on physician overconfidence
as a contributing cause of errors, strategies to improve the accuracy of diagnostic
decision making, and recommendations for future research.