A Model for Clinical Decision-Making in Medicine

The last decade has witnessed an unmasking of diagnostic failure along with the recognition that it is a major source of morbidity and mortality. It is now regarded as the dominant threat to patient safety. While healthcare systems are responsible, in part, for what goes wrong in failed diagnostic processes, a greater measure of accountability lies with the ways in which physicians think, reason, solve problems, and make decisions. This has led to a growing awareness of the need for explicit training in clinical decision-making during medical training. Drawing heavily on the cognitive sciences literature, a consensus has emerged that rationality is the essential characteristic of the well-calibrated decision-maker. Cognitive and affective biases, in turn, are critical determinants of the rationality of the decision-maker. Incorporating developments in several adjacent areas, we can now assemble a model that embraces the major components of clinical decision-making. Its properties are outlined here.