Diversion and deviation: how distracting contextual factors amplify cognitive biases in clinical reasoning.

Clinical reasoning occurs in busy environments where interruptions, workload, and contextual pressures can distort thinking. This simulation study examines how distractions amplify cognitive biases and increase diagnostic vulnerability. Physicians watched video encounters of common disorders with or without added distracting influences, then completed a post-session form and a think-aloud exercise to render their thinking process transparent to allow for analysis. The authors argue that improving diagnosis requires addressing both individual reasoning skills and the workplace conditions in which decisions are made.