Decision Making

Clinical Instability Is a Sign of Severity of Illness: A Cohort Study

“…An important component of clinical assessment is based on pattern recognition, identifying similarities to previously encountered examples or learned patterns (25). In cognitive psychology, this type of thinking is termed system 1 or "intuitive" thinking, in contrast to system 2 or "adaptive expertise" which is characterized as slower and more analytic thinking (27)(28)(29). Intuitive thinking is invaluable in dynamic settings, such as the ICU, where lack of time, multiple competing priorities, and heavy cognitive load are a part of this complex clinical environment (27).…”

“…In cognitive psychology, this type of thinking is termed system 1 or "intuitive" thinking, in contrast to system 2 or "adaptive expertise" which is characterized as slower and more analytic thinking (27)(28)(29). Intuitive thinking is invaluable in dynamic settings, such as the ICU, where lack of time, multiple competing priorities, and heavy cognitive load are a part of this complex clinical environment (27). Recently, experts have proposed there is a "cognitive continuum" where both types of thinking operate in concert, and that little, if any, problem solving is performed by either cognitive system in isolation (27,30).…”

Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias

“…To overcome an emergency intervention and stabilise a patient who is critically ill, an experienced clinician usually relies on system 1. Following rapid assessment of clinical signs, with an often incomplete history and with little time to analyse the situation in depth, the doctor will instinctively treat the patient using intuitive reasoning [2].…”

“…Clinicians, based on intuitive thinking and past experiences, create heuristics, i.e. mental shortcuts to rapidly assist in dealing with complex problems [2]. The reason why heuristics perform so well is that some information is ignored, thereby reducing cognitive workload [37].…”

“…Making a correct diagnosis represents one of the most complex tasks confronting clinicians. This is particularly pertinent in the intensive care unit (ICU) setting where clinicians must frequently work simultaneously at multiple levels, trying to stabilise the physiological condition while establishing a diagnosis and communicating information [2]. Moreover, the clinical features of a patient who is acutely ill with organ dysfunction are common to multiple potential underlying causes.…”