Diagnostic Errors in Clinical Reasoning: A Comprehensive Literature Review on Cognitive Processes, Causes, and Error Reduction Strategies

Pekcan and Coşkun Diagnostic Thinking in Clinical Reasoning

Abstract

Diagnostic decision-making in complex and uncertain clinical settings relies heavily on diagnostic thinking as a core component of clinical reasoning. As healthcare complexity increases, understanding how physicians and medical students reason is essential for ensuring patient safety and quality of care. This review explores the evolution of diagnostic models from early hypothetico-deductive frameworks to contemporary knowledge-based and dual-process perspectives. A narrative synthesis was conducted by drawing on the literature from major biomedical and educational databases, including PubMed, Web of Science, and Scopus. The review focused on conceptual and empirical discussions regarding cognitive processes, diagnostic errors, and error-reduction strategies in clinical practice. Diagnostic errors, which often arise from incomplete data collection or misinterpretation of findings, significantly contribute to patient harm and increased healthcare costs. Notably, interpretation errors are resistant to improvement through clinical experience alone, emphasizing the role of cognitive biases and underdeveloped mental representations (illness scripts). Contextual factors, such as time pressure and physician density, further influence diagnostic accuracy. Reducing diagnostic errors requires targeted educational efforts to enhance pattern recognition, metacognitive awareness, and the systematic use of debiasing strategies. Integrating artificial intelligence as a supportive tool and adopting constructive terminology, such as “missed diagnostic opportunities,” may foster a more reflective and safe diagnostic environment.