Clinical Decision Making - Essay Example

?Clinical Decision Making Why is it difficult to distinguish between clinical-decision making errors solely due to intuitive judgment or analytical judgment? Paramedics do not work in perfect conditions with all the medical instruments they require in order to make the right decision. They usually have to take into account the fact that the patient may have extra symptoms of distress that are less obvious or whose identity can only be revealed by more sophisticated medical equipment. In such cases, the paramedics have to use deeper reflection to consider all the possibilities (Pelaccia, Tardif, Triby and Charlin 2011). Experience is particularly helpful in such circumstances. However, even in the case of experienced paramedics, this can present difficulties. The danger is in the bias produced by both the intuitive judgment and analytical judgment. If the paramedic focuses too much on the unusual characteristic(s), a characteristic of paramedics who use guidelines to inspect patients, he or she may ignore other aspects unintentionally (Rajkomar and Dhaliwal 2011). On, the other hand, intuitive judgment could also present problems. When a paramedic relies too much on intuitive judgment he or she may unconsciously ignore more subtle signs that are not often seen in his or her work experience. It therefore becomes difficult to determine, particularly when errors are made, where exactly the error was made during the process of diagnosing the illness in the patient. Current literature points to a debate surrounding the reliability of intuitive clinical reasoning in comparison to the analytical, hypothetico-deductive, process of reasoning. Discuss and debate current findings. The intuitive clinical reasoning process is typically experiential, intuitive, or tacit. It is a reactive process whose activation takes place in automated mode. It generates an intuitive response, in that this response is produced without effort and is beneath the threshold of discernible consciousness (Ferreira, Ferreira, Rajgor, Shah, Menezes and Pietrobon 2010). The intuitive process is therefore quite swift. It makes use of aspects such as the visual information which is readily available, and functions on the premise of the identification of a characteristic pattern of signs, or of comparisons with previously encountered situations. The approach of the clinician is holistic as well as partial (Bendall and Morrison 2009). The partial aspect is because only part of the existing information may be processed; while the holistic aspect may be because the clinician or paramedic may make a general evaluation of the situation and then approximate. The reaction that is produced instinctively is highly reliant on contextual signals or indicators. The second type of clinical reasoning is identified as the analytical reasoning and it is usually rational or deliberate (Jensen, Croskerry and Travers 2009). This type of reasoning is made from a cogent and deliberate judgment that is based on supplementary information that is gathered actively by the clinician in his or her environment, and the cognizant application of regulations that have been gained through learning. It is a somewhat gradual process that can be quite demanding for cognition. It has been hypothesized that clinical reasoning patterns are at variance between novice and expert clinicians (Fournier, Demeester and Charlin 2008). Pattern recognition is usually only possible when there are a lot of inexperienced clinicians and a well-ordered knowledge base, and, as a result, is usually not used by untested clinicians. It has been suggested that clinicians who have just completed their studies but have no experience in their field use the model of hypothesis-testing clinical reasoning on a more frequent basis. In most clinical situations, pattern recognition permits clinicians to devise management options and diagnostic assumptions swiftly and instinctively (Sibbald and Cavalcanti 2011). These will be ruled out systematically through a hypothetico-deductive procedure. The hypothetico-deductive model is still viewed as the most durable clinical reasoning model in the practice of medicine. This method is mostly used by doctors when the intuitive scheme is not capable of creating quick relevant solutions to multifaceted or uncommon medical symptoms. In such circumstances, clinicians make a conscious choice to use their patho-physiological knowledge. The popularity of the hypothetico-deductive model, though, does not mean that the intuitive method is ignored. To some degrees, intuition is continuously involved in the processes of clinical reasoning. This is a very significant element, since for virtual centuries, medicine has perceived professional intuition as a ‘mysterious’ ability that is not easily reached by the doctor’s conscious thoughts (Xu, Xu, Yu, Ma and Wang 2012). Emphasizing the value of intuition in the field of medicine is connected with many significant clinical concerns. The significance of the physical or emotional symptoms may be a major determinant of the effectiveness of the process of intuitive reasoning. Indeed, unrelated information is likely to be mixed up with the process of pattern recognition and can actually result in diagnostic blunders. This also applies where the over or under-appreciation of contextual cues is concerned. Why is clinical reasoning a ‘bounded’ process? Bounded rationality is an expression used to define a particular decision-making process. It is not really a unified theory, but is mainly an acknowledgment that decision making in practice usually does not match the notion of rationality which is the foundation of many recognized behavioural models. In bounded rationality, clinicians endeavour to make accurate decisions, but their decision-making procedure does not fulfil all of the criteria that are considered as being necessary for a clinician to be said to be using full rationality. Bounded rationality is probably best understood by contrasting it against the fully rational factors that are presumed in most formal behavioural models. In past clinical researches, cognitive processing research has established that bounded rationality is a limitation to the process of complex cognition. Bounded rationality describes the situation where decision makers, in this case, clinicians, are limited in their capacity to look for a solution. The clinicians therefore make the decision to choose the first choice that satisfies or meets the minimum standards for resolving the causes of the illness in their patient instead of maintaining the search for the most favourable solution. Considering different alternatives may be dependent on a number of different influences, which maintain the position that clinicians can be subject to decision influences that are non-rational. Clinical reasoning is descriptive of the variety of bounded rationality in which the clinician changes a problem with no obvious endpoint to being a number of possibilities, each of which have a hypothesized endpoint. The open problem is changed to be an assortment of closed problems that categorize the search for the real issue or cause of a patient’s illness. Also, diagnosis is not a fixed endpoint but an active way station on the road to medical treatment. Even before the patient is observed, the clinician may have accumulated cues, for instance, from different aspects in the environment. Before questioning the patient, the paramedic observes the patient’s face, eyes, clothes, skin, coordination, gait, voice and posture in order to recognize salient signals such as being elderly, anaemic, worried-looking, or frail. The clinician must be observant of pertinent cues, differentiating them from the general noise in the perceptual field. To begin with, the paramedic consider a wide range of options as potential causes so as to increase the chance of correctly identifying salient cues, probably at the expense of perceiving information that is later viewed as being irrelevant. As the diagnostic procedure progresses, however, the collection of evidence is more focused. The clinician’s deportment, receptiveness and sympathetic way of communicating inspire the patient to tell of more problems, if any others subtle ones exist. References Bendall, J., & Morrison, A. (2009) Clinical judgement in Paramedics in Australia Contemporary challenges of practice, Pearson Education Australia, Frenchs Forest, NSW. Ferreira, A. P. R. B., Ferreira, R. F., Rajgor, D., Shah, J., Menezes, A. &Pietrobon, R. (2010) ‘Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines’, PloS One, vol. 5, no. 4. Fournier, J., Demeester, A. & Charlin, B. (2008) ‘Script concordance tests: guidelines for construction’, BMC Medical Informatics and Decision Making, vol. 8, no. 1, p. 18. Jensen, J. L., Croskerry, P. & Travers, A. H. (2009) ‘Consensus on paramedic clinical decision making during high-acuity emergency calls: results of a Canadian delphi study’, BMC Emergency Medicine, vol. 9, no. 1, pp. 17. Pelaccia, T., Tardif, J., Triby, E. & Charlin, B. 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