An analysis of clinical reasoning through a recent and comprehensive approach: the dual-process theory

Abstract

Context: Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. Purpose: This paper aims at exploring a comprehensive approach: the ''dual-process theory'', a model developed by cognitive psychologists over the last few years. Discussion: After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians' intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.

A 60-Year-Old Woman with Chorea and Weight Loss

“…The dual-process theory, described in the cognitive psychology literature, has become a front-runner model to explain the process of clinical reasoning in medicine. 10 The theory describes two systems used by clinicians to make diagnostic decisions-the intuitive and the analytical approaches. In the intuitive approach, the clinician uses illness scripts to quickly identify common presentations of disorders as described above.…”

La naturaleza dual del proceso diagnóstico y su vulnerabilidad a los sesgos cognitivos

“…[5][6][7] De acuerdo a esta teoría se utilizan dos sistemas cognitivos en el razonamiento: el sistema intuitivo y el sistema analítico, que trabajan en forma complementaria (Figura 1).…”

“…La generación de hipótesis en forma intuitiva es tan importante que si la hipótesis correcta es generada en los primeros cinco minutos, hay 95% de posibilidades de llegar al diagnóstico correcto, en cambio si la hipótesis correcta no se genera en los primeros cinco minutos, hay 95% de posibilidades de no llegar al diagnóstico correcto 6 .…”

Introduction

“…Somewhat simplified, they are categorized in two thinking systems, sometimes subsumed under the name dual-process theory (Eva 2005;Kassirer 2010;Croskerry 2009;Pelaccia et al 2011). Based in the work of Croskerry (2009) and the Institute of Medicine (Balogh et al 2015), Fig.…”