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Dr.Kartik Sonawane Verified account @KartikBSonawane
โš ๏ธ ๐Ž๐ฐ๐ง๐ข๐ง๐  ๐ญ๐ก๐ž ๐๐ฅ๐จ๐œ๐ค ๐ข๐ง ๐ญ๐ก๐ž ๐†๐ซ๐ž๐ฒ ๐™๐จ๐ง๐ž: ๐–๐ก๐ž๐ง ๐‡๐ฎ๐ฆ๐š๐ง ๐„๐ซ๐ซ๐จ๐ซ๐ฌ ๐’๐ก๐š๐ฉ๐ž ๐‘๐ž๐ ๐ข๐จ๐ง๐š๐ฅ ๐€๐ง๐ž๐ฌ๐ญ๐ก๐ž๐ฌ๐ข๐š ๐Ž๐ฎ๐ญ๐œ๐จ๐ฆ๐ž๐ฌ ๐Ÿ›‘ #RegionalAnesthesia #GreyZone #HumanFactors #PatientSafety #StopBeforeBlock #CognitiveErrors #NerveBlockSafety #AnesthesiaEducation #EDRA #DecisionMaking #SafetyFirst #GrayZoneInRA #GrayAreasInRA ๐†๐‘๐€๐˜ ๐™๐Ž๐๐„๐’ ๐ข๐ง ๐‘๐€ 1๏ธโƒฃ ๐Ÿง  ๐‡๐ฎ๐ฆ๐š๐ง ๐…๐š๐œ๐ญ๐จ๐ซ๐ฌ: ๐“๐ก๐ž ๐’๐ข๐ฅ๐ž๐ง๐ญ ๐ƒ๐ž๐ญ๐ž๐ซ๐ฆ๐ข๐ง๐š๐ง๐ญ ๐Ÿ‘‰ Even in the era of ultrasound precision, uncertainty persists and so does the operatorโ€™s judgment. ๐Ÿ‘‰ In grey zones, itโ€™s not the needle - but the decision behind it that determines outcome. ๐Ÿ‘‰ Most complications arise not from equipment failure, but from cognitive lapses under uncertainty. 2๏ธโƒฃ ๐Ÿ“Š ๐‡๐จ๐ฐ ๐Ž๐Ÿ๐ญ๐ž๐ง ๐ƒ๐จ ๐„๐ซ๐ซ๐จ๐ซ๐ฌ ๐Œ๐š๐ญ๐ญ๐ž๐ซ? Reported complication rates remain low (โ‰ˆ0.03โ€“0.2%) ๐Ÿ” 70โ€“80% of adverse events involve human factors ๐Ÿ“‰ Near-misses are frequent yet invisible, especially in borderline decisions ๐Ÿ‘‰ Grey zones donโ€™t create errors - they expose them 3๏ธโƒฃ โš ๏ธ ๐‚๐จ๐ฆ๐ฆ๐จ๐ง ๐„๐ซ๐ซ๐จ๐ซ๐ฌ ๐Ÿงญ Ambiguous anatomy โ†’ Misinterpretation, misplaced needle ๐Ÿ’‰ Dose uncertainty โ†’ Over/under-dosing in high-risk patients โ†’ LAST ๐Ÿ‘๏ธ Suboptimal visualization โ†’ Proceeding despite doubt โฑ๏ธ Rushing decisions โ†’ Skipping safety pauses ๐Ÿ”„ Failure to adapt โ†’ Continuing a failing or unclear block 4๏ธโƒฃ ๐Ÿง  ๐‚๐จ๐ ๐ง๐ข๐ญ๐ข๐ฏ๐ž ๐๐ข๐ญ๐Ÿ๐š๐ฅ๐ฅ๐ฌ ๐ŸŽฏ Overconfidence bias โ†’ โ€œThis looks familiarโ€ in an unfamiliar anatomy ๐Ÿ” Automation error โ†’ Routine approach in a non-routine patient ๐Ÿงฉ Fixation error โ†’ Persisting despite poor image or resistance ๐Ÿ“‰ Complacency with ultrasound โ†’ Trusting the screen over clinical sense 5๏ธโƒฃ ๐Ÿงช ๐’๐ฒ๐ฌ๐ญ๐ž๐ฆ + ๐‡๐ฎ๐ฆ๐š๐ง ๐ˆ๐ง๐ญ๐ž๐ซ๐š๐œ๐ญ๐ข๐จ๐ง ๐Ÿšซ Absence of structured protocols โ†’ Amplifies variability in grey zones ๐Ÿ”Š Communication gaps โ†’ Wrong-site / wrong-block decisions ๐Ÿฅ Fatigue & workload โ†’ Reduced cognitive bandwidth for complex decisions 6๏ธโƒฃ ๐Ÿ›‘ ๐–๐ก๐ž๐ง ๐†๐ซ๐ž๐ฒ ๐™๐จ๐ง๐ž๐ฌ + ๐„๐ซ๐ซ๐จ๐ซ๐ฌ โ†’ ๐‚๐จ๐ฆ๐ฉ๐ฅ๐ข๐œ๐š๐ญ๐ข๐จ๐ง๐ฌ โšก Nerve injury โ†’ Misjudged needle path under uncertainty โค๏ธ LAST โ†’ Dose decisions without recalibration ๐Ÿซ Pneumothorax โ†’ Landmark ambiguity ignored ๐Ÿฉธ Hematoma โ†’ Incomplete risk assessment (e.g., anticoagulation) 7๏ธโƒฃ ๐Ÿ›‘ ๐’๐“๐Ž๐ ๐๐„๐…๐Ž๐‘๐„ ๐๐‹๐Ž๐‚๐Š ๐Ÿ‘‰ The last moment to think before you act โœ”๏ธ Reconfirm patient, side, indication โœ”๏ธ Re-evaluate anatomy & imaging clarity โœ”๏ธ Recalculate dose & risk profile โœ”๏ธ Reconsider: Proceed / Modify / Abandon โœ”๏ธ If doubt persists โ†’ STOP. Seek help. 8๏ธโƒฃ ๐Ÿ›ก๏ธ ๐„๐ซ๐ซ๐จ๐ซ-๐๐ซ๐จ๐จ๐Ÿ๐ข๐ง๐  ๐ข๐ง ๐”๐ง๐œ๐ž๐ซ๐ญ๐š๐ข๐ง๐ญ๐ฒ ๐Ÿ‘๏ธ โ€œSee the tip, feel the pathโ€ โ†’ Dual sensory vigilance ๐Ÿ’‰ Fractionated injection + aspiration โ†’ No blind bolus ๐Ÿ” Dynamic reassessment โ†’ Before, during, after block ๐Ÿค Team cognition โ†’ Share uncertainty, not just decisions ๐ŸŒŸ ๐Š๐„๐˜ ๐“๐€๐Š๐„๐€๐–๐€๐˜๐’ ๐ŸŽฏ ๐Ÿงฉ Regional anesthesia is not just technical - it is decision-making under uncertainty โš ๏ธ Grey zones are inevitable; errors are not ๐Ÿš€ Mastery lies in anticipating, recognizing, and intercepting errors -especially when certainty is low ๐Ÿ‘‰ The safest block is not the one you perform perfectly, but the one where you pause, question, and respect uncertainty before you proceed.
KartikBSonawane's tweet photo. โš ๏ธ ๐Ž๐ฐ๐ง๐ข๐ง๐  ๐ญ๐ก๐ž ๐๐ฅ๐จ๐œ๐ค ๐ข๐ง ๐ญ๐ก๐ž ๐†๐ซ๐ž๐ฒ ๐™๐จ๐ง๐ž: ๐–๐ก๐ž๐ง ๐‡๐ฎ๐ฆ๐š๐ง ๐„๐ซ๐ซ๐จ๐ซ๐ฌ ๐’๐ก๐š๐ฉ๐ž ๐‘๐ž๐ ๐ข๐จ๐ง๐š๐ฅ ๐€๐ง๐ž๐ฌ๐ญ๐ก๐ž๐ฌ๐ข๐š ๐Ž๐ฎ๐ญ๐œ๐จ๐ฆ๐ž๐ฌ ๐Ÿ›‘ #RegionalAnesthesia #GreyZone #HumanFactors #PatientSafety #StopBeforeBlock #CognitiveErrors #NerveBlockSafety #AnesthesiaEducation #EDRA #DecisionMaking #SafetyFirst #GrayZoneInRA #GrayAreasInRA ๐†๐‘๐€๐˜ ๐™๐Ž๐๐„๐’ ๐ข๐ง ๐‘๐€ 1๏ธโƒฃ ๐Ÿง  ๐‡๐ฎ๐ฆ๐š๐ง ๐…๐š๐œ๐ญ๐จ๐ซ๐ฌ: ๐“๐ก๐ž ๐’๐ข๐ฅ๐ž๐ง๐ญ ๐ƒ๐ž๐ญ๐ž๐ซ๐ฆ๐ข๐ง๐š๐ง๐ญ ๐Ÿ‘‰ Even in the era of ultrasound precision, uncertainty persists and so does the operatorโ€™s judgment. ๐Ÿ‘‰ In grey zones, itโ€™s not the needle - but the decision behind it that determines outcome. ๐Ÿ‘‰ Most complications arise not from equipment failure, but from cognitive lapses under uncertainty. 2๏ธโƒฃ ๐Ÿ“Š ๐‡๐จ๐ฐ ๐Ž๐Ÿ๐ญ๐ž๐ง ๐ƒ๐จ ๐„๐ซ๐ซ๐จ๐ซ๐ฌ ๐Œ๐š๐ญ๐ญ๐ž๐ซ? Reported complication rates remain low (โ‰ˆ0.03โ€“0.2%) ๐Ÿ” 70โ€“80% of adverse events involve human factors ๐Ÿ“‰ Near-misses are frequent yet invisible, especially in borderline decisions ๐Ÿ‘‰ Grey zones donโ€™t create errors - they expose them 3๏ธโƒฃ โš ๏ธ ๐‚๐จ๐ฆ๐ฆ๐จ๐ง ๐„๐ซ๐ซ๐จ๐ซ๐ฌ ๐Ÿงญ Ambiguous anatomy โ†’ Misinterpretation, misplaced needle ๐Ÿ’‰ Dose uncertainty โ†’ Over/under-dosing in high-risk patients โ†’ LAST ๐Ÿ‘๏ธ Suboptimal visualization โ†’ Proceeding despite doubt โฑ๏ธ Rushing decisions โ†’ Skipping safety pauses ๐Ÿ”„ Failure to adapt โ†’ Continuing a failing or unclear block 4๏ธโƒฃ ๐Ÿง  ๐‚๐จ๐ ๐ง๐ข๐ญ๐ข๐ฏ๐ž ๐๐ข๐ญ๐Ÿ๐š๐ฅ๐ฅ๐ฌ ๐ŸŽฏ Overconfidence bias โ†’ โ€œThis looks familiarโ€ in an unfamiliar anatomy ๐Ÿ” Automation error โ†’ Routine approach in a non-routine patient ๐Ÿงฉ Fixation error โ†’ Persisting despite poor image or resistance ๐Ÿ“‰ Complacency with ultrasound โ†’ Trusting the screen over clinical sense 5๏ธโƒฃ ๐Ÿงช ๐’๐ฒ๐ฌ๐ญ๐ž๐ฆ + ๐‡๐ฎ๐ฆ๐š๐ง ๐ˆ๐ง๐ญ๐ž๐ซ๐š๐œ๐ญ๐ข๐จ๐ง ๐Ÿšซ Absence of structured protocols โ†’ Amplifies variability in grey zones ๐Ÿ”Š Communication gaps โ†’ Wrong-site / wrong-block decisions ๐Ÿฅ Fatigue & workload โ†’ Reduced cognitive bandwidth for complex decisions 6๏ธโƒฃ ๐Ÿ›‘ ๐–๐ก๐ž๐ง ๐†๐ซ๐ž๐ฒ ๐™๐จ๐ง๐ž๐ฌ + ๐„๐ซ๐ซ๐จ๐ซ๐ฌ โ†’ ๐‚๐จ๐ฆ๐ฉ๐ฅ๐ข๐œ๐š๐ญ๐ข๐จ๐ง๐ฌ โšก Nerve injury โ†’ Misjudged needle path under uncertainty โค๏ธ LAST โ†’ Dose decisions without recalibration ๐Ÿซ Pneumothorax โ†’ Landmark ambiguity ignored ๐Ÿฉธ Hematoma โ†’ Incomplete risk assessment (e.g., anticoagulation) 7๏ธโƒฃ ๐Ÿ›‘ ๐’๐“๐Ž๐ ๐๐„๐…๐Ž๐‘๐„ ๐๐‹๐Ž๐‚๐Š ๐Ÿ‘‰ The last moment to think before you act โœ”๏ธ Reconfirm patient, side, indication โœ”๏ธ Re-evaluate anatomy & imaging clarity โœ”๏ธ Recalculate dose & risk profile โœ”๏ธ Reconsider: Proceed / Modify / Abandon โœ”๏ธ If doubt persists โ†’ STOP. Seek help. 8๏ธโƒฃ ๐Ÿ›ก๏ธ ๐„๐ซ๐ซ๐จ๐ซ-๐๐ซ๐จ๐จ๐Ÿ๐ข๐ง๐  ๐ข๐ง ๐”๐ง๐œ๐ž๐ซ๐ญ๐š๐ข๐ง๐ญ๐ฒ ๐Ÿ‘๏ธ โ€œSee the tip, feel the pathโ€ โ†’ Dual sensory vigilance ๐Ÿ’‰ Fractionated injection + aspiration โ†’ No blind bolus ๐Ÿ” Dynamic reassessment โ†’ Before, during, after block ๐Ÿค Team cognition โ†’ Share uncertainty, not just decisions ๐ŸŒŸ ๐Š๐„๐˜ ๐“๐€๐Š๐„๐€๐–๐€๐˜๐’ ๐ŸŽฏ ๐Ÿงฉ Regional anesthesia is not just technical - it is decision-making under uncertainty โš ๏ธ Grey zones are inevitable; errors are not ๐Ÿš€ Mastery lies in anticipating, recognizing, and intercepting errors -especially when certainty is low ๐Ÿ‘‰ The safest block is not the one you perform perfectly, but the one where you pause, question, and respect uncertainty before you proceed.
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APSForg's profile image
APSF @APSForg
#CognitiveErrors play a role in adverse events during #airwaymanagement, but may be addressed through targeted simulation training, debriefing, and case conferences. Read more in the October 2025 #APSFNewsletter! #anesthesia #patientsafety https://t.co/IhyVrml1uK
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KirollosRoman's profile image
Kirollos Roman @KirollosRoman
#MedTwitter #ClinicalReasoning #CognitiveBias #CognitiveErrors @medrants @DxRxEdu @rabihmgeha @PrathitKulkarni @Dr_Oubre @ryankraemr @LisaWillett13 @starrgazed @LaurenNassetta
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sovrennofficial's profile image
Sovrenn @sovrennofficial
Did you know our decisions are more influenced by psychology than by financial theory? Watch this space to know more! #psychology #emotions #cognitiveerrors #sovrenn #investmentbehaviour #behavioralinsights #stockinvestingindia #atmanirbharbharatiya
sovrennofficial's tweet photo. Did you know our decisions are more influenced by psychology than by financial theory? Watch this space to know more! #psychology #emotions #cognitiveerrors #sovrenn #investmentbehaviour #behavioralinsights #stockinvestingindia #atmanirbharbharatiya https://t.co/I0aTAdmU6G
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Saif Farooqi, PhD @saiffarooqi
3 Cognitive Errors That Can Lead to Rumination | Psychology Today https://t.co/hP53JcyRMR @PsychToday @DrAliceBoyes #CognitiveErrors #Rumination
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SMoreChrisBoyd's profile image
J. Christopher Boyd @SMoreChrisBoyd
CIO, Brian Regan, CFAยฎ, gives a market retrospect, discussing #MarketDrivers like #EarningReports, #inflation, a long-term #InterestRate outlook, and more. He shares #EmotionalBiases and #CognitiveErrors #investors can have on their #investments. #Podcast https://t.co/AavToOvZVD
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Abby Spencer, MD, MS, FACP @abbyWUim
๐Ÿฅณ๐Ÿฉบ๐Ÿง ๐Ÿฅณ๐Ÿฉบ๐Ÿง ๐Ÿ“š๐Ÿ“šSo much fun to deliver @WashUIMRes noon conference today on #PatientSafety #CognitiveErrors & #ClinicalReasoning! Many thanks to @MohitHarshMD for the invite & great questions! #MedEd As internists, clinical reasoning is our most critical tool! ๐Ÿง ๐Ÿ”ง๐Ÿ”จโš’๐Ÿ› โš™๏ธ๐Ÿง 
abbyWUim's tweet photo. ๐Ÿฅณ๐Ÿฉบ๐Ÿง ๐Ÿฅณ๐Ÿฉบ๐Ÿง ๐Ÿ“š๐Ÿ“šSo much fun to deliver @WashUIMRes noon conference today on #PatientSafety #CognitiveErrors & #ClinicalReasoning! Many thanks to @MohitHarshMD for the invite & great questions! #MedEd As internists, clinical reasoning is our most critical tool! ๐Ÿง ๐Ÿ”ง๐Ÿ”จโš’๐Ÿ› โš™๏ธ๐Ÿง  https://t.co/yWlCwi21tL
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Kevin Viner @theKevinViner
Change blindness is a real thing ... wait for the end. #mentalist #magician #cognitiveerrors
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TRE Radio App @TRERadioApp
On #TheDaily @Davehodgson1976 is chatting to @KimberlySReed , @Cognisant2000 and #RolfDobelli From 4pm CET #Optimism #LifeTools #Motivational #AreYouAHostageToYourDeveloper #WebDesign #ClearThinking #CognitiveErrors
TRERadioApp's tweet photo. On #TheDaily @Davehodgson1976 is chatting to @KimberlySReed , @Cognisant2000 and #RolfDobelli From 4pm CET #Optimism #LifeTools #Motivational #AreYouAHostageToYourDeveloper #WebDesign #ClearThinking #CognitiveErrors https://t.co/jT1uPFpt2E
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TRE Talk Radio Europe @TRETalkRadio
On #TheDaily @Davehodgson1976 is chatting to @KimberlySReed , @Cognisant2000 and #RolfDobelli From 4pm CET #Optimism #LifeTools #Motivational #AreYouAHostageToYourDeveloper #WebDesign #ClearThinking #CognitiveErrors
TRETalkRadio's tweet photo. On #TheDaily @Davehodgson1976 is chatting to @KimberlySReed , @Cognisant2000 and #RolfDobelli From 4pm CET #Optimism #LifeTools #Motivational #AreYouAHostageToYourDeveloper #WebDesign #ClearThinking #CognitiveErrors https://t.co/s0rM4F9TZu
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Mays Ali MD @MaysAliMD
Had a blast recording with the @cardionerds team alongside my co-fellows @CharlieJainMD @KoroshMD the one-and-only @RickNishimura and our fabulous PD @fvbrozovich! Check it out to learn more about #constriction #MR #cognitiveerrors
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CardioNerds @CardioNerds
Ep59 #CNCR: Constrictive Pericarditis w MR - w/ @MayoClinicCV @MaysAliMD @CharlieJainMD @KoroshMD, @RickNishimura & @fvbrozovichโ€ผ๏ธ ๐Ÿ”—https://t.co/Qlj1ndY0mW๐ŸŽ† โœ…CP review โ˜‘๏ธ MR/TR tx โœ…Avoiding cognitive errors Notes & Tweetorial @varghes_bibin w/ mentorship by @karanpdesai
CardioNerds's tweet photo. Ep59 #CNCR: Constrictive Pericarditis w MR - w/ @MayoClinicCV @MaysAliMD @CharlieJainMD @KoroshMD, @RickNishimura & @fvbrozovichโ€ผ๏ธ ๐Ÿ”—https://t.co/Qlj1ndY0mW๐ŸŽ† โœ…CP review โ˜‘๏ธ MR/TR tx โœ…Avoiding cognitive errors Notes & Tweetorial @varghes_bibin w/ mentorship by @karanpdesai https://t.co/46F6L68Gvb
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mindmypeelings's profile image
Iโ€™m Going Bananas ๐ŸŒ @mindmypeelings
Challenge Blaming: โ€ข Avoid playing victim role โ€ข See from otherโ€™s perspective โ€ข Take responsibility for your role โ€ข Identify solutions and move on https://t.co/lsHMtNOBP8 #cognitiveerrors #blaming #blamingothers
mindmypeelings's tweet photo. Challenge Blaming: โ€ข Avoid playing victim role โ€ข See from otherโ€™s perspective โ€ข Take responsibility for your role โ€ข Identify solutions and move on https://t.co/lsHMtNOBP8 #cognitiveerrors #blaming #blamingothers https://t.co/ZphPwxQWYh
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Sherine Salib @DrSherineSalib
@dellmedimres @SocietyGIM @JournalGIM Remember: When the Problem Representation & the Illness Script do not align: โžก๏ธ Pause for a โ€œDiagnostic Time Outโ€. Ask yourself, โ€œAm I missing something?โ€ #MedEd #ClinicalReasoning @DellMedIMRes #MedStudentTwitter #CognitiveErrors
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Sherine Salib @DrSherineSalib
Avoiding #CognitiveErrors in Clinical Decision Making: 1. Reshuffle DDx based on relative prevalence 2. Use Diagnostic Schema to โฌ‡๏ธ anchoring 3. Use your medical note as built-in cross-check 4. Work in teams 5. Diagnostic time-out if things donโ€™t align #MedEd @AnnalsofIM
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Annals of Int Med Verified account @AnnalsofIM
"Avoiding Cognitive Errors in Clinical Decision Making" by authors from @MassGeneralNews, @harvardmed | 2 cases outlined in Annals: https://t.co/VfK7jfPxj3.
AnnalsofIM's tweet photo. "Avoiding Cognitive Errors in Clinical Decision Making" by authors from @MassGeneralNews, @harvardmed | 2 cases outlined in Annals: https://t.co/VfK7jfPxj3. https://t.co/1YdlsmPTXl
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psychepi's profile image
Melissa Raven @psychepi
Ross (1995) chapter3 โ€˜Pseudoscience in The American Journal of Psychiatryโ€™ = really useful critical #annotatedbibliography of key #AJP articles, focusing on #cognitiveerrors. But itโ€™s not referred to as an anno biblio, so it would be unlikely to be located via literature search
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saiffarooqi's profile image
Saif Farooqi, PhD @saiffarooqi
ยท New Delhi
You got to accept the greys of life. It's not just about black or white ... #clouds #cloudy #sky #rainy #rain #windy #grey #white #black #thinking #cognition #blackandwhitethinking #allornone #cognitiveerrorsโ€ฆ https://t.co/yyDNhxKlo9
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PIPSQC's profile image
PIPSQC @PIPSQC
Thinking fast and slow in medicine https://t.co/mgHPA07Kuq @HardeepSinghMD @MarkGraber @ImproveDX #improvedx #dxerror #dxerrors #misdiagnosis #diagnosticsafety #diagnosticerror #diagnosticerrors #cognitivebias #cognitiveerror #cognitiveerrors
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PracticumScript's profile image
Practicum Script @PracticumScript
Geoff Norman, McMaster University, (Canada), on slowing down to reduce #diagnosticerrors: "Accuracy is associated with shorter time, longer time reflects uncertainty." #AMEE2019 #CognitiveErrors #Biases
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medpedshosp's profile image
Med Peds Hospitalist Verified account @medpedshosp
Agree w @ShreyaTrivediMD - we always must be alert and avoid anchoring biases. Even if a disease is labeled as โ€œchronicโ€ must be curious to assess its current status. #payaytentiontodetail #cognitiveerrors
ShreyaTrivediMD's profile image
Shreya P. Trivedi MD, MHPE @ShreyaTrivediMD
1/ By far, one of the most dangerous words in medicine is โ€œchronicโ€ Similar to a high-alert medications, to me, โ€œchronicโ€ is a high-alert label
ShreyaTrivediMD's tweet photo. 1/ By far, one of the most dangerous words in medicine is โ€œchronicโ€ Similar to a high-alert medications, to me, โ€œchronicโ€ is a high-alert label https://t.co/N0i8q0b65Z
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Jay_rides's profile image
Prof. Dr. Jan Kiesewetter @Jay_rides
Last year we investigated the effects of #scaffolding of #clinicalreasoning of medical students and the effects on #diagnosticaccuracy, efficiency, and #errors and today the article came out https://t.co/2LmqtY0DEm #diagnosticerrors #cognitiveerrors
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