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Thinking Again
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08 December 2025

Early assessments of medical errors frequently focused on deficiencies in procedures and systems, yet research shows that 75% of those errors are individual and cognitive. And although typical medical training calls for the learning, storing, and recalling of large amounts of information, few medical professionals receive instruction on how to recognize, anticipate, and avoid innate mechanisms that can easily lead to cognitive error.
Thinking Again: Reducing Cognitive Errors in Psychiatric Practice offers insight and direction into reducing the cognitive errors routinely made by mental health and other medical providers. Beyond professional satisfaction, the author argues that making this effort can lead to improved assessment, formulation, treatment planning, and patient outcomes.
Opening with four clinical vignettes that illustrate the range and variety of cognitive mistakes, this volume goes on to discuss the following:
• The brain's neurocognitive processes
• The merits and shortcomings of diverse methods of thought used in various forms of clinical reasoning
• Challenges to clinical reasoning, including misuse of heuristics, groupthink, and overreliance on artificial intelligence
• The effect of practitioner physical and mental health and activity on cognitive function
• Practices for reducing cognitive error, from learning and applying metacognition to debiasing and seeking multisource feedback
In each chapter, readers will find a summary, list of key points, self-assessment questions, discussion topics for individual or group use, suggestions for further reading, and references to support the material.
The book closes with a thoughtful consideration of the ethical duty of mental health clinicians to be aware of and seek to reduce cognitive errors, modeling new behaviors for the good of patients and other practitioners alike.
MEDICAL / Psychiatry / General
H. Paul Putman III, M.D., is a Distinguished Life Fellow at the American Psychiatric Association and a Fellow at the American College of Psychiatrists. He is based in Austin, Texas.
Acknowledgements
Introduction. Remaining Conscious of Our Cognitive Processes During Clinical Practice
Chapter 1. Cognitive Errors in Practice
Chapter 2. The Study of Cognitive Processing
Chapter 3. Clinical Reasoning
Chapter 4. Challenges to Clinical Reasoning
Chapter 5. Practitioner Mental Health, Well-being, and Clinical Error
Chapter 6. Best Practices for Reducing Cognitive Error
Chapter 7. Practicing Self-Examination
Chapter 8. Metacognitive Duty and Rewards