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
Reliability of a test as a questionnaire means that the questionnaire is measuring something in a reproducible way.Â Validity on the other handÂ means that the questionnaire is measuring what is intended to. In situations where other scales of the same or similar attributes are available, outcomes of an existing scale and the new one administered to a sample of people may be compared with their correlation indicating the validity of the new scale. However, if no other measure pre-exists, another approach is necessary called Â´construct validityÂ´.(1) 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
Theoretical saturation of data is a term in qualitative research, mostly used in the grounded theory approach. Theoretical saturation of data means that researchers reach a point in their analysis of data that sampling more data will not lead to more information related to their research questions.(1) No additional data can be found to develop new properties of categories and the relationships between the categories are disentangled. Researchers see in their data similar instances over and over again and that make them empirically confident that their categories are saturated, the descriptions of these categories are thick and a theory can emerge. Researchers are allowed to stop sampling data and to round off their analysis. read more
The aim of a Delphi consensus procedure, named after the ancient Delphic oracle, is to determine the extent to which people agree about a given issue or to develop consensus. (1;2) This anonymous process can be organized by inviting experts to discussÂ on the matter or relevant individuals to rate their agreement on opinions e.g. statements, on a scale e.g.Â from 1 (total disagreement) to 9 (total agreement), and to give comments. 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