Thinking About Thinking

Abstract

Thinking, problem-solving, and decision-making are skills we often take for granted but are at the core of providing good medical practice. Medical schools and post-graduate training programs do not include any formal instruction of the principles and mechanics of clinical decision-making. They assume that the medical student or resident will develop good thinking and decision-making skills almost by osmosis in the course of their training. We would like to think physicians and other care providers are somehow “scientific” or “logical” when making decisions. This viewpoint is flawed and inaccurate. Our thought processes may be, based on outdated or erroneous knowledge, illogical or influenced by our memories, emotions, and biases—errors we may be totally unaware of. We are not always the best judge of our knowledge or capabilities, factors important to making the best decision or obtaining the best result for the patient. We make decisions using many different approaches, approaches usually chosen subconsciously, and our decisions are often influenced by time constraints, the urgency of the situation, or the presence of flawed or inadequate information. As a result, the approach chosen to solve a problem may be inappropriate for the problem at hand. Good decision-making requires an understanding of the principles and approaches available for making a decision. Decision-making is a discipline that can be studied and learned.

Different situations require different cognitive strategies. How we decide should depend on what we are deciding.

(Lehrer 2009, page. 166)