Psychological dual-process theories contrast analytical reasoning and non-analytical reasoning as two modes of knowing and thinking1-6.
The analytical system or system 2 is explicit, controlled, rational, effortful and relatively slow. In clinical reasoning, analytical thinking is present in deliberately generating and testing of diagnostic hypotheses, in causal reasoning with biomedical knowledge, and in the use of decision tools. The non-analytical system or system 1 is implicit, based on automatic and effortless thought processes and is associative, intuitive and fast. It can be seen as a process leading rapidly to the selection of the preferred management options for the target condition.1;7 Non-analytical reasoning can be recognized both in medical decision-making and in medical problem-solving, for instance in automatic chance assessment processes and in pattern recognition. The interaction between these two systems is considered to determine the output of the whole thought process. The outcomes of the non-analytical system can be reflected upon by the analytical system and accepted or elaborated upon for further understanding and investigation or to provide explanations.1;8;9 Non-analytical, intuitive thinking is explained in terms of the high accessibility of the immediate thoughts.10 read more
In their diagnostic process, GPs combine large amounts of knowledge they have accumulated during their personalÂ training. They consider illness scripts or prototypes, which they then accept or reject. At the same time, considering diagnostic data also implies a quantitative process, namely assessing the probability that the patient has a particular disease. Thomas Bayes (1702-1761) formulated in mathematical terms how the probability of a particular conclusion â€“ in medicine a diagnosis â€“ is altered by new data that become available, for instance from history-taking or examination. Bayesian logic can be described as a mathematical rule combining prior information with evidence from data.(1;2) read more
Internalized, collectively reinforced and tacit guidelines that are implemented and refined by cliniciansÂ´ training, by their own and others experience, along their interaction with their role sets, from reading,Â in the way they have learned to handle the conflicting demands, from their understanding of local circumstances and systems and through a host of other sources.
In the cognitive continuum theory, intuition and rational analysis are defined as two modes of cognition that can be placed at the ends of a continuum, where intuition refers to rapid, unconscious processing and low control, and analysis refers to slow, conscious and controlled processing.(1-3) Most thinking is situated at specific placesÂ somewhere in between, and the appropriate mode of thought depends on the specific task characteristics. read more
In cognitive consistency theories, consistency is often referred to as the desire to maintain congruence among oneâ€™s cognitions, namely beliefs, attitudes and values. (1;2) In other words, people must be consistent in their cognitive systems and tend towards homeostasis, i.e. balance or equilibirum. If there is no balance, we experience a tension, which may result in behaviour change.(3;4) read more
Contextual knowledge can be defined as everything a physician knows from his/her patient apart from the signs and symptoms. Contextual knowledge seems to be a major determinant of gut feelings in a GPâ€™s diagnostic reasoning process.(1;2) In the illness script model contextual factors are described as those illness features that are associated with the acquisition of the illness, so-called â€˜enabling conditionsâ€™ like sex and age, or risk factors originating from work, behavior and hereditary taint.(3) read more
A diagnosis is the summary conclusion from signs and symptoms thatÂ a patient presents, plus the results of physical examination and laboratory investigation. â€˜Clinical diagnosis is, at whatever stage of the diagnosis-oriented process of fact-finding, the correspondingÂ perception of a personâ€™s current (or past) state of health. In these terms, diagnosis of a particular illness is a perception of its presence/absence first and foremost: and if clearly perceived to be present,Â more detailed diagnosis is a perception of particulars of that case of the illness (at the time).â€™(1) Diagnoses can stay on a symptom level (e.g. fatigue) or reach the highest level where the patho-anatomical/physiological cause(s) and treatment are implicitly included (e.g. Hashimotoâ€™s hypo-thyroidism). The International Classification of Primary Care (ICPC) is the WONCA acknowledged and worldwide used summary of practically all diagnoses prevalent in primary care.(2-5) Â Diagnoses are mostly needed to make treatment or management choices in clinical practice. read more
Many GPs experience so-called gut feelings in their diagnostic reasoning about patients, a specific kind of intuitive feelings usually confined to prognostic assessments of the patientâ€™s situation and often accompanied by bodily sensations.(1;2) These may act as a compass, steering GPs through busy office hours and enabling them to handle complex problems.(3) read more
A heuristic is a simple, fast and easy to apply rule or behavioural pattern.(1-3)Â Only a limited amount of external data and little cognitive effort are needed for its execution. A heuristic can be a powerful tool if it is adapted to the particular environment. A heuristics can be unconscious or deliberate. read more
Intuitive feelings are generally defined as thoughts that come to mind without apparent effort.(1-4) Intuition is known to be acquired by learning processes.(5;6) Some systematic processes of retrieval or integration of information generate intuitions unconsciously influencing behaviour. read more