Medical Decision-Making and Medical Problem Solving

Tuesday, May 14th, 2013

Medical Decision Making and Medical Problem Solving are two main approaches used to describe the cognitive processes underlying clinical diagnosis.(1) This distinction is the result of historical factors. A diagnosis is a statement about what disease someone has ( based on symptoms (subjectively) and signs (objectively).(2) Medical decision making (MDM) models are concerned with diagnostic reasoning as an opinion revision process.(3) They make use of Bayes’ theorem, likelihood ratios, prior and posterior odds, thresholds, schemes and decision trees to arrive at the best diagnostic and therapeutic decisions. (1;3-7) These mathematical models, incorporating clinical epidemiological data, are related to the concept of evidence-based medicine. read more

Pattern recognition

Sunday, November 24th, 2013

In routine cases, experienced physicians immediately recognize the correct diagnoses. The direct retrieval of relevant knowledge is an automatic non-analytical process that is often referred to as pattern recognition.(1;2) This immediate understanding of a patient’s problem in diagnostic terms is based on an automatic information integration process such as categorization and problem representation(2-4) or on the instant recognition of similarity to a previously seen case stored in memory.(1;5) read more

Rules of thumb

Friday, November 15th, 2013

The terms ‘heuristics’ and ‘rule of thumb’ are often used as synonyms, but there are some differences in meaning.(1) A rule of thumb was explained as a rough practical rule that was based on practice and experience. Most likely the saying comes from the length of the first joint of the thumb, which is about one inch. read more

System 1 and System 2

Wednesday, November 27th, 2013

System 1 and  System 2 refer to the psychological dual-process theories developed in  cognitive psychology which contrast analytical reasoning and non-analytical reasoning as two modes of knowing and thinking processes.(1;2) The system 1 or the non-analytical system (see also in this glossary) can be seen as a process leading rapidly to the selection of the preferred management options for the target condition.(3) The system 1 is implicit, based on automatic and effortless thought processes and is associative, intuitive and fast. Non-analytical, intuitive thinking is explained in terms of the high accessibility of the immediate thoughts(4). 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(5). It acts unconsciously and is used most of the time by the health care experts for common conditions.(6) read more

Tacit knowlegde

Wednesday, November 27th, 2013

Tacit knowledge (as opposed to formal or explicit knowledge) is the implicit (personal) knowledge that  is not directly accessible and difficult to transfer to another person by means of writing it down or verbalizing (“that which we know but cannot tell”). The term and its definition were first developed by Michael Polanyi (1891-1976). Tacit knowledge has been described as “know-how”  as opposed to “know-what” (facts), “know-why” (science) or “know who” (networking).(1-6) read more


Wednesday, November 27th, 2013

Uncertainty refers to the subjective experience of having insufficient information about a problem of interest.(1;2) A person may be able to reduce uncertainty by collecting informative data. However, often information does not exist in the human domain (question has not been researched) or is not available (not published or not retrievable) – epistemic uncertainty (ignorance).(3) Uncertainty is due to a lack of information – we „don‘t know“! In addition, uncertainty may result from the structure of the environment itself (large number of relevant factors [complexity] or probabilistic nature of the phenomenon of interest) – aleatoric uncertainty (ambiguity).(3) In the latter case, uncertainty is confirmed by the data, i.e. “we are certain to be uncertain”, and uncertainty cannot be reduced by learning. All these sources are relevant for medical diagnosis, prognosis, treatment and prevention. read more