To the Editor.
—Caplan et al1 showed an outcome bias in physician evaluations of patient care. In research on error, it is critical to distinguish outcome failures from deficiencies or defects in the decision-making or problem-solving process.Not all defects in decision processes are associated with bad outcomes; other factors may be necessary for the defect to propagate along a chain of negative consequences.2 Conversely, bad outcomes can occur despite good decisions, ie, despite complete and thorough consideration of all of the available information, goals, and contributing factors.3 Appreciating this fundamental aspect of human decision behavior is critical for
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