Like everyone else, physicians take shortcuts when processing complex information. Unfortunately, mistakes in diagnosis often result. This chapter applies what we know about cognitive errors to better understand the likelihood that a baby who presents with one or more triad symptoms will be diagnosed with SBS. In a typical clinical setting, cognitive biases that tend to lead to errors readily present themselves. These biases raise real questions about the rigor of “differential diagnosis,” the methodology that purports to rule out causes of the triad other than shaking. Overall, sustained examination of causation evidence, the rule in civil cases, has not penetrated criminal court, where judges are faced seemingly unawares with comparable admissibility decisions yet reflexively admit the proffered expert testimony. A look at SBS cases where missed diagnoses ultimately were identified shows that we cannot rely on our adversary system of justice to forestall the conviction of innocents.
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