CME article part 1: Visual perception, cognition and error in dermatologic diagnosis

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Christine J. Ko, Irwin Braverman, Richard Sidlow, Eve Lowenstein

Abstract

Dermatologic diagnosis relies on vision primarily and auditory and verbal input secondarily. Accurate dermatologic diagnosis is predicated on 1) seeing and perceiving a skin finding, 2) categorizing and naming the finding correctly, and 3) comparing the visual data and data obtained from the totality of the clinical encounter (i.e., from other sensory modalities) with one's working mental database of dermatologic diagnoses. The baseline assumption – which is false - is that a dermatologist is expert at each of the aforementioned steps and transitions sequentially between them seamlessly in an error-free fashion. Each of these steps has inherent challenges, and the transitions between steps can also be problematic. In part one of this 2-part paper, we describe the pitfalls associated with visual recognition. In part 2, we discuss cognitive heuristics as they relate to the dermatologic diagnostic process and prevention of diagnostic error.

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