Clinical Judging and Decision Making

For the biomedical practitioner, clinical judgments and decisions are objective and modeled after the judging and decision making processes of the natural sciences. “The assumption that clinical reasoning is applied scientific reasoning,” claims Mattingly, “underlies nearly all research on clinical reasoning in medical fields, and the informal perceptions of practicing health professionals” (1998, p. 275). For humanistic practitioners, clinical judgments and decisions reflect a subjective reasoning process, which includes the patient’s personal information and values and which also involves the patient’s narration of the illness experience.

Although there are profound differences between biomedical and humanistic or humane practitioners, the general outline of the process for clinical judgments and decisions are to some extent similar. That process, or “journey” as Engelhardt (1979) calls it, begins with collecting data and making observations and is followed by hypotheses formation and testing, after which judgments and decisions concerning the patient’s disease state and the best way to proceed therapeutically must be made by both the physician and patient. The difference between biomedical and humane practitioners concerns the role, if any, of logic or intuition in the process of judging and deciding the best course of action, as detailed in the previous chapter. Often the debate revolves around whether the physician must adhere to strict guidelines or can utilize gut feelings. But as some commentators note, clinical judgments and decision making are complex notions and “in their rich and full sense are freighted with values, including ethical and moral values” (Engelhardt, 1979, p. xxii). In this chapter, the nature of clinical judgment, which is often considered informal in nature, is examined first, followed by the clinical decision making, which is generally modeled formally.