Introduction to clinical reasoning
How do doctors make decisions? Alison Round explains some of the thought processes that lead to a diagnosis
Doctors make decisions all the time - what the problem is, what the diagnosis is, whether to do anything, what to do. What facts do doctors take into account when they come to a decision, and what processes do they use to decide on a course of action? Where does intuition come from? These are the basics of clinical reasoning. When decisions are made in conjunction with the patient, doctors need to have an understanding of the “building blocks” of their thinking in order to explain this to the patient and to explore areas where differences in values and opinion may occur.
In all fields, not just medicine, experts make decisions in very different ways from students or beginners. Traditional bedside teaching guides students to take a history and perform an examination before constructing a differential diagnosis. In real life, however, experienced doctors do not work like this. They utilise