clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2020-98-4-307-314clinmed-51Research ArticleДИСКУССИЯDISCUSSIONВрачебные ошибки и профессиональный опытDoctor errors and professional experiencehttps://orcid.org/0000-0003-3743-5262МахамбетчинМ. М.MakhambetschinM. M.

Махамбетчин Мурат Максутович — кандидат медицинских наук, старший научный сотрудник, доцент.

010009, Нур-Султан.

Murat M. Makhambetschin — MD, PhD senior researcher, associate professor.

010009, Nur-Sultan.

murat.makhambetchin@mail.ruhttps://orcid.org/0000-0002-7802-1464ШакеевК. Т.ShakeyevK. T.

100017, Караганда.

100017, Karaganda.

Научно-исследовательский институт травматологии и ортопедии Республики КазахстанКазахстанScientific Research Institute of Traumatology and Orthopedics of the Republic of KazakhstanKazakhstanМедицинский университет КарагандыКазахстанMedical University of KaragandaKazakhstan202018092020984307314Copyright © Махамбетчин М.М., Шакеев К.Т., 20202020Махамбетчин М.М., Шакеев К.Т.Makhambetschin M.M., Shakeyev K.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/51

Профессиональный опыт врача — основа его деятельности. Приведен пошаговый механизм формирования опыта в медицине. Отрицательный и профессиональный опыт врача представлены в сравнении. Показана связь опыта врача с анализом ошибок. Рассмотрены составляющие опыта. Обсуждается феномен стереотипа и его роль в опыте и возникновении ошибок у врачей. Приведена структура причин отдельной ошибки врача. Подчеркивается важность понимания взаимоотношения ошибки и опыта в решении проблемы ошибок в медицине.

The professional experience of a doctor is the basis of his activity. A step-by-step mechanism for the formation of experience in medicine is given. The negative and professional experience of the doctor is presented in comparison. The connection of the doctor's experience with the analysis of errors is shown. The components of experience are considered. The phenomenon of stereotype and its role in the experience and occurrence of errors in doctors are discussed. The structure of the causes of a single doctor's error is given. The importance of understanding the relationship of error and experience in solving the problem of errors in medicine is emphasized.

врачебные ошибкиотрицательный опытпрофессиональный опытпамятьстереотипыпереоценка клинического фактанедооценка клинического фактаmedical errorsnegative experienceprofessional experiencememorystereotypesreassessment of clinical factunderestimation of the clinical factReferencesФоменко А.Г. Медицинские ошибки, или приглашение к разговору о безопасности пациентов. Государственная служба медицинских судебных экспертиз. 2008;45(879):06 ноября. URL: http://medvestnik.by/ru/issues/a_2061.html/ Дата обращения: 11.03.2017 г.Fomenko A.G. Medical errors, or an invitation to talk about patient safety. State service of medical forensic examinations. 2008; 45(879): November 06. (in Russian) URL: http://medvestnik.by/ru/issues/a_2061.html/ Date of access: 11.03.2017.Becher E.C., Chassin M.R. Improving Quality, Minimizing Error: Making It Happen. Health Aff airs. 2001;20(3):68-81. URL: http://content.healthaffairs.org/content/20/3/68.full.pdf.Becher E.C., Chassin M.R. Improving Quality, Minimizing Error: Making It Happen. Health Aff airs. 2001;20(3):68-81. URL: http://content.healthaffairs.org/content/20/3/68.full.pdf.Groopman J. How Doctors Think. United States: Houghton Mifflin; 2007;320.Groopman J. How Doctors Think. United States: Houghton Mifflin; 2007;320.Horton R. What's Wrong with Doctors. The New York Review of Books. 2007;54.Horton R. What's Wrong with Doctors. The New York Review of Books. 2007;54.Saposnik G., Redelmeier D., Ruff C.C., Tobler P.N. Cognitive biases associated with medical decisions: a systematic review. BMC. Med. Inform. Decis. Mak. 2016;16(1):138.Saposnik G., Redelmeier D., Ruff C.C., Tobler P.N. Cognitive biases associated with medical decisions: a systematic review. BMC. Med. Inform. Decis. Mak. 2016;16(1):138.Motterlini M. Cognitive traps and clinical decisions. G. Ital. Cardiol. (Rome). 2017;18(12):809-13. doi: 10.1714/2815.28462.Motterlini M. Cognitive traps and clinical decisions. G. Ital. Cardiol. (Rome). 2017;18(12):809-13. doi: 10.1714/2815.28462.Gabler M. Cognitive errors in diagnostic decision making. Wien Med. Wochenschr. 2017;167(13-14):333-42. doi: 10.1007/s10354-017-0570-6. Epub. 2017; May 23. Review. German. PubMed PMID: 28536918.Gabler M. Cognitive errors in diagnostic decision making. Wien Med. Wochenschr. 2017;167(13-14):333-42. doi: 10.1007/s10354-017-0570-6. Epub. 2017; May 23. Review. German. PubMed PMID: 28536918.Lowenstein E.J., Sidlow R. Diagnostic heuristics in dermatology, part 2: metacognition and other fixes. Br. J. Dermatol. 2018;179(6):1270-6. doi: 10.1111/bjd.17127. Epub. 2018; Oct 14.Lowenstein E.J., Sidlow R. Diagnostic heuristics in dermatology, part 2: metacognition and other fixes. Br. J. Dermatol. 2018;179(6):1270-6. doi: 10.1111/bjd.17127. Epub. 2018; Oct 14.Itri J.N., Patel S.H. Heuristics and Cognitive Error in Medical Imaging. AJR. Am. J. Roentgenol. 2018;210(5):1097-105. doi: 10.2214/AJR.17.18907.Itri J.N., Patel S.H. Heuristics and Cognitive Error in Medical Imaging. AJR. Am. J. Roentgenol. 2018;210(5):1097-105. doi: 10.2214/AJR.17.18907.Hussain A., Oestreicher J. Clinical decision-making: heuristics and cognitive biases for the ophthalmologist. Surv. Ophthalmol. 2018;63(1):119-24. doi: 10.1016/j.survophthal.2017.08.007.Hussain A., Oestreicher J. Clinical decision-making: heuristics and cognitive biases for the ophthalmologist. Surv. Ophthalmol. 2018;63(1):119-24. doi: 10.1016/j.survophthal.2017.08.007.Mezzio D.J., Nguyen V.B., Kiselica A., O'Day K. Evaluating the Presence of Cognitive Biases in Health Care Decision Making: A Survey of U.S. Formulary Decision Makers. J. Manag. Care Spec. Pharm. 2018;24(11):1173-83. doi: 10.18553/jmcp.2018.24.11.1173Mezzio D.J., Nguyen V.B., Kiselica A., O'Day K. Evaluating the Presence of Cognitive Biases in Health Care Decision Making: A Survey of U.S. Formulary Decision Makers. J. Manag. Care Spec. Pharm. 2018;24(11):1173-83. doi: 10.18553/jmcp.2018.24.11.1173Richie M., Josephson S.A. Quantifying Heuristic Bias: Anchoring, Availability, and Representativeness. Teach Learn Med. 2018;30(1): 67-75. doi: 10.1080/10401334.2017.1332631.Richie M., Josephson S.A. Quantifying Heuristic Bias: Anchoring, Availability, and Representativeness. Teach Learn Med. 2018;30(1):67-75. doi: 10.1080/10401334.2017.1332631Surry L.T., Torre D., Trowbridge R.L., Durning S.J. A mixed-methods exploration of cognitive dispositions to respond and clinical reasoning errors with multiple choice questions. BMC. Med. Educ. 2018;18(1):277. doi: 10.1186/s12909-018-1372-2.Surry L.T., Torre D., Trowbridge R.L., Durning S.J. A mixed-methods exploration of cognitive dispositions to respond and clinical reasoning errors with multiple choice questions. BMC. Med. Educ. 2018;18(1):277. doi: 10.1186/s12909-018-1372-2.Shlonsky A., Featherston R., Galvin K.L., Vogel A.P., Granger C.L., Lewis C., Luong M.L., Downie L.E. Interventions to Mitigate Cognitive Biases in the Decision Making of Eye Care Professionals: A Systematic Review. Optom. Vis. Sci. 2019;96(11):818-24. doi: 10.1097/OPX.0000000000001445.Shlonsky A., Featherston R., Galvin K.L., Vogel A.P., Granger C.L., Lewis C., Luong M.L., Downie L.E. Interventions to Mitigate Cognitive Biases in the Decision Making of Eye Care Professionals: A Systematic Review. Optom. Vis. Sci. 2019;96(11):818-24. doi: 10.1097/OPX.0000000000001445.Balakrishnan K., Arjmand E.M. The Impact of Cognitive and Implicit Bias on Patient Safety and Quality. Otolaryngol. Clin. North Am. 2019;52(1):35-46. doi: 10.1016/j.otc.2018.08.016.Balakrishnan K., Arjmand E.M. The Impact of Cognitive and Implicit Bias on Patient Safety and Quality. Otolaryngol. Clin. North Am. 2019;52(1):35-46. doi: 10.1016/j.otc.2018.08.016.Royce C.S., Hayes M.M., Schwartzstein R.M. Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Acad Med. 2019;94(2):187-94. doi: 10.1097/ACM.0000000000002518.Royce C.S., Hayes M.M., Schwartzstein R.M. Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Acad Med. 2019;94(2):187-94. doi: 10.1097/ACM.0000000000002518.Altabbaa G., Raven A.D., Laberge J. A simulation-based approach to training in heuristic clinical decision-making. Diagnosis (Berl). 2019;6(2):91-9. doi: 10.1515/dx-2018-0084.Altabbaa G., Raven A.D., Laberge J. A simulation-based approach to training in heuristic clinical decision-making. Diagnosis (Berl). 2019;6(2):91-9. doi: 10.1515/dx-2018-0084.Большая советская энциклопедия. М. : Советская энциклопедия. 1969-1978. Т. 18. Ч. 3.Bolshaya Sovetskaya enciklopediya, Moscow: Sovetskaya enciklopediya. 1969-1978. Vol. 18. Part 3. (in Russian)Постовит В.А. Диагноз и диагностика в клинической медицине. Учебное пособие. Л. : ЛПМИ; 1991; 103. URL: http://lekmed.ru/info/arhivy/diagnoz-i-diagnostika-v-klinicheskoy-medicine-7.html.Postovit V. A. Diagnosis and diagnostics in clinical medicine. Textbook. L.: LPMI; 1991; 103. (in Russian) URL: http://lekmed.ru/info/arhivy/diagnoz-i-diagnostika-v-klinicheskoy-medicine-7.html.Постовит В.А. О значении опыта в практической деятельности врача. Клиническая медицина. 1991;(2):112-4.Postovit V.A. on the meaning of experience in the practice of a doctor. Klinicheskaya meditsina. 1991;(2):112-4. (in Russian)Кушнир В. И опыт — сын ошибок трудных (из воспоминаний старого врача). Мистецтво лткування. 2004; 4.Kushnir V. And experience is the son of difficult mistakes (from the memories of an old doctor). Art treatment. 2004; 4. (in Russian)Гуглин Э. Клинические этюды. URL: http://guglin.ru/book.Guglin E. Clinical studies. URL: http://guglin.ru/book. (in Russian)Гиршин С.Г. Клинические лекции по неотложной травматологии. СПб.: Азбука, 2004: 543.Girshin S.G. Clinical lectures on emergency traumatology. Saint Petersburg: Azbuka, 2004: 543. (in Russian)Тетенев Ф.Ф., Бодрова Т.Н., Калинина О.В. Формирование и развитие клинического мышления — важнейшая задача медицинского образования. Успехи современного естествознания. 2008;4:63-5.Tetenev F.F., Bodrova T.N., Kalinina O.V. Formation and development of clinical thinking — the most important task of medical education. Uspekhi sovremennogo estestvoznaniya. 2008;4:63-5. (in Russian)Осповат Б.Л., Копылов А.И. Острые хирургические заболевания брюшной полости под маской пищевой токсикоинфекции. (Библиотека практического врача). М.: 1971: 196.Ospovat B.L., Kopylov A.I. Acute surgical diseases of the abdominal cavity under the mask of food toxicoinfection. (Library of the practical doctor). Moscow: 1971: 196. (in Russian)Мондор Г. Неотложная диагностика. Живот. Т. 2. Издатель: Книга по требованию, 2012:366.Mondor G. Emergency diagnosis. Belly. Vol. 2. Publisher: Book on demand, 2012: 366. (in Russian)

The authors declare that there are no conflicts of interest present.