Clinical Reasoning and Decision Making Flashcards
What are the contextual factors in our decision making?
- People
- Places
- Time
- Pressures
The ‘ideal’ or normative approach
- Establish the chief complaint(s)
- Develop a differential diagnosis
- Perform a history and physical examination
- Order laboratory or imaging studies
- Establish a provisional diagnosis(es)
- Implement a management plan
Establishing chief complaint(s)
First or repeat interaction?
* How long does the patient get to talk before being interrupted?
* Who leads the conversation?
* Is there always a simple “chief complaint”?
Differential Diagnosis
Developing a list of the possible conditions that might produce the presenting symptoms and signs.
* Symptoms are described by the person/carers (subjective)
* Signs are what can be measured (objective)
A differential diagnosis ensures that you do not accidently exclude possibilities by jumping to conclusions (it is a runny nose therefore it is just a cold).
History and examination
- Interview
- Records (history)
- Physical examination
- Psychological evaluation
- Office tests
- Laboratory tests
- Medical Imaging
- Surgical procedures
Provisional Diagnosis and Management Plan
Provisional diagnosis is the most likely condition according to the given evidence.
The Management Plan is based on more than the diagnosis, it must accommodate:
* Person centred care
* Access to services
* The biopsychosocial approach
The Clinical Reasoning Cycle
- Clinical reasoning is on ongoing cycle
- You don’t necessarily go in a simple circle, but may go back
before you go forward
How we decide
System One
Intuitive
System Two
Analytical
System One: Intuitive Decision Making
Pattern recognition
* “Gut feeling”
* Fast
* Almost at an unconscious level
* Used by experts rather than novices
* Tends to increase in accuracy with contextual experience
System One: Intuitive Decision Making cont.
Selecting a response based on: identification of a previously known outcome
weighing some inputs over others (determining importance)
personal bias and professional expertise
Heuristics
shortcuts or rule of thumb
Used to look for patterns
When intuitive decision making is used, we look for mental shortcuts
The more experienced, the more shortcuts we create
Shortcuts give quick results BUT
- can jump to conclusions
- ignore additional evidence
Problems with Intuitive Decision Making
Flawed information
* Intuitive decision making will respond quickly to inaccurate, insufficient, unreliable, or incomplete information based on patterns from previous experiences.
Short term emotional bias
* Cognitive research has shown that even experts’ decisions are influenced by unrelated emotions during the time of making a decision.
Problems with Intuitive Decision Making cont.
Insufficient consideration of alternatives
* Intuition generally relies on pattern recognition and will point to solutions that have worked well with the current perceived pattern. This will limit considered options even though you may be dealing with a new decision situation that might
require a novel or unique solution.
Prejudices
* Emotions help form our intuition and can allow
flawed experiences to overrule sound facts and evidence.
Problems with Intuitive Decision Making cont.
Lack of openness
* Every person has a different experience base that provides the platform for their intuitions.
Given that one’s intuition is not easily explained, it is difficult to use intuition in a group context.
Inappropriate application
* People that have good experience, expertise, and intuition in one area can become overconfident and apply their intuition in an unfamiliar or unrelated area.
System Two Analytical
Using logic and a methodical procedure
* Conscious
* Deliberate
* Slower
* Can be more reliable
