Case 1 - clinical reasoning Flashcards
what is the definition of clinical reasoning
complex cognitive process, context dependent
way of thinking for diagnostic or therapeutic decision making in clinical practice
features of clinical reasoning
an active process
no good or bad answers
never ending process, it is possible to integrate additional data at any moment
what feeds into clinical reasoning
clinical skills
Use and interpretation of tests
Understanding cognitive bias
Critical thinking
Evidence based medicine
Shared decision making
what is system 1 of the dual process theory
no feeling of voluntary control / automatic
Little effort
Quick / careless
loves to tell a story
Loves to feel comfort / ease
Generally efficient
what is system 2 of the dual process theory
Deliberate allocation of attention
Effortful
Slow / careful
easily fatigued
Lazy
Quite inefficient
examples of process 1 activities
judge distance / length
Complete phrases : salt and …..
2+2=4
Understand simple sentences
Drive your car on a quiet road / familiar trip
An experienced physician diagnosing Parkinson’s Disease in clinic!!!
examples of system 2 activities
ready, steady….BANG
Count the numbers of vowels on this slide
Fill out foundation programme application form
Park in a narrow space
Decide between 2 laptops
Evaluate pros and cons in a debate
An inexperienced physician diagnosing Parkinsons
what can repeated practice of something in system 2 lead to
it to be pushed into system 1
dual process theory diagram
what is the importance of context and cognitive errors in reasoning
the dual process theory demonstrates how the two decision making systems are actually constantly interconnected by toggling, executive and irrational override and overarching this is calibration or meta cognition (moment to moment self regulation).
Important for us to understand that they are not simply working in one or the other, and that they are trying to achieve system 1 to become a competent doctor.
Important to realise that all doctors are constantly in and out of both, but may not be explicit.
Gives students permission to ask the doctor how they came to their diagnosis
Also explains how even experienced doctors can lack expertise if they don’t do the meta-cognition stuff to regulate their cognitive processes.
medical errors occur in how many cases in primary care
10-15%
what are the different types of errors
no-fault error: e.g the patient gave the wrong information, didn’t take their treatment…
System related errors e.g unable to obtain a CT scan immediately, surgeon already in the operating theatre
Human based and cognitive errors, e.g SOB patient and I failed to consider or rule out pulmonary embolism in the differential diagnosis. Seems to be the most frequent error.
what are the different error types
framing
Anchoring
Availability
Diagnostic momentum
Blind obedience
Premature closure
how to correct these error types, respectively
examine from a fresh perspective
Formally estimate probability, 2nd option
Question influence of past experience
You don’t have to go with the flow, keep asking ‘what if’
How reliable is this test? Limitations?
Have you considered alternatives?
