Clinician Mindfulness and Patient Safety

PATIENT SAFETY HAS BEEN A TOPIC OF CONSIDERABLE interest over the last decade, with evidence showing that medical errors are responsible for substantial morbidity and mortality. There has been significant progress in understanding, identifying, and addressing errors at a system level; however, the performance of individual clinicians remains a crucial and largely unaddressed element of patient safety. Individual performance is important in diagnostic errors, but these errors are difficult to measure and have received little systematic study. Diagnostic errors often stem from cognitive biases, also referred to as “cognitive dispositions to respond” (CDRs). Because CDRs are integral to human cognition, they are challenging to overcome. Croskerry has delineated more than 30 CDRs and has proposed “debiasing strategies” to prevent errors due to CDRs. Prominent among these strategies is metacognition, or an individual’s knowledge of his or her own thinking process. Notably, there is significant overlap between metacognition and mindfulness, nonjudgmental awareness of the present moment. Increased mindfulness leads to greater awareness and understanding of a person’s experiences, including thoughts, emotions, and bodily sensations. Because education can increase mindfulness, mindfulness instruction for clinicians holds promise as a debiasing strategy for reducing diagnostic and other medical errors.