Scott does well to decorticate the traps inherent in medical
reasoning (1).
Medical reasoning is however one sub-set of the much wider, more complex
algorithm of how human beings reach decisions and indeed how they reach
the right or at least better decisions. Decision-making may or may not be
discernibly rational, may be conscious and (arguably) subconscious. A
debate
raging in the field of cognitive and popular psychology (2) is whether
subconscious rumination leads to better decision-making than acting on
instinct alone without the opportunity for considered thought. The
popularist
Malcolm Gladwell in his book BLINK the power of thinking without thinking
(3) asserts that acting on first instincts alone leads to equivalent or
even
better decisions than an iterative thought process. By extension a
diagnostic
or management decision may empirically transpire to be the correct one
regardless of whether the decision making process followed a logically
coherent and deductively water-tight plan, in the same way that
'intelligent
guesswork' might prove to be the strategy of choice in an MCQ exam.
Mapping one’s heuristic preferences, how they work for you might therefore
indicate how we individually reach better and correct decisions
Finally, restricting ourselves purely to the reasoning element of the
debate we
must insist on applying the same order of stringency to the debiasing
strategies or corrective maxims he proposes, which are surely no more than
heuristic devices by another name. Equally a number of so-called errors
of
reasoning identified by Scott “treat the patient and not the numbers” vs
“I
payed too much attention to the laboratory result” appear distinctly
antinomical though that perhaps is precisely why they each work when
instinct dictates that they must.
References:
1. Scott I. Errors in Clinical Reasoning: causes and remedial
strategies. BMJ
2009; 338: b1860.
2. Dijksterhuis A, Bos MW, Nordgren LF, van Baaren RB. On making the
right
choice: the deliberation-without-attention effect. Science 2006; 311:
1005-
7.
3. Gladwell M. Blink: The power of thinking without thinking.
Penguin books
2006.
Rapid Response:
A Critique of Pure Reason
Dear Editor,
Scott does well to decorticate the traps inherent in medical
reasoning (1).
Medical reasoning is however one sub-set of the much wider, more complex
algorithm of how human beings reach decisions and indeed how they reach
the right or at least better decisions. Decision-making may or may not be
discernibly rational, may be conscious and (arguably) subconscious. A
debate
raging in the field of cognitive and popular psychology (2) is whether
subconscious rumination leads to better decision-making than acting on
instinct alone without the opportunity for considered thought. The
popularist
Malcolm Gladwell in his book BLINK the power of thinking without thinking
(3) asserts that acting on first instincts alone leads to equivalent or
even
better decisions than an iterative thought process. By extension a
diagnostic
or management decision may empirically transpire to be the correct one
regardless of whether the decision making process followed a logically
coherent and deductively water-tight plan, in the same way that
'intelligent
guesswork' might prove to be the strategy of choice in an MCQ exam.
Mapping one’s heuristic preferences, how they work for you might therefore
indicate how we individually reach better and correct decisions
Finally, restricting ourselves purely to the reasoning element of the
debate we
must insist on applying the same order of stringency to the debiasing
strategies or corrective maxims he proposes, which are surely no more than
heuristic devices by another name. Equally a number of so-called errors
of
reasoning identified by Scott “treat the patient and not the numbers” vs
“I
payed too much attention to the laboratory result” appear distinctly
antinomical though that perhaps is precisely why they each work when
instinct dictates that they must.
References:
1. Scott I. Errors in Clinical Reasoning: causes and remedial
strategies. BMJ
2009; 338: b1860.
2. Dijksterhuis A, Bos MW, Nordgren LF, van Baaren RB. On making the
right
choice: the deliberation-without-attention effect. Science 2006; 311:
1005-
7.
3. Gladwell M. Blink: The power of thinking without thinking.
Penguin books
2006.
Competing interests:
None declared
Competing interests: No competing interests