Concepts and theories of clinical decision-making

A key concept in decision-making is that of heuristics; these are rules of thumb or strategies that assist in reasoning (Fonteyn and Ritter, 2008) and assist the processing of large amounts of data. These devices are important to clinicians, but are often taken for granted by those with experience. Familiarity with heuristics can enable health professionals to gain awareness of how these factors may influence their clinical judgements. Short cuts are developed with the processing of irrelevant data when formulating clinical judgements. Much of the time clinicians employ those heuristics most readily available in their mind, although these can introduce bias; for example, based on case examples from clinical experience which may or may not be relevant, with the individual being either representative or not of the cases typically seen. This may apply to initial clinical assessments or the evaluation of dermatological treatments. Anchoring heuristics are cognitive reference points or anchors, which can guide decisions. In dermatology, such devices are important in formulating assessment or diagnostic judgements about lesions. The classification systems described earlier in this section provide such heuristic aids to the pattern recognition of lesions and rashes.

One theory of reasoning, which gives an insight into the explanation of how clinical judgements are formed, is the Hypothetico-deductive theory. This is based on the work of Elstein et al. (1978), with the key processes being cue acquisition (such as a raised erythematous scaly plaque), hypothesis generation and cue interpretation (chronic plaque psoriasis) and hypothesis evaluation – that is, reviewing how well this fits with the clinical examination of the individual (Carnevali and Thomas, 1993). Such work is recognised to have relevance to nursing (Tanner et al., 1987).