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Beyond thinking fast and slow: a Bayesian intuitionist model of clinical reasoning in real-world practice

  • Isaac K.S. Ng EMAIL logo , Wilson G.W. Goh and Tow Keang Lim
Published/Copyright: December 10, 2024
Diagnosis
From the journal Diagnosis Volume 12 Issue 2

Abstract

Clinical reasoning is a quintessential aspect of medical training and practice, and is a topic that has been studied and written about extensively over the past few decades. However, the predominant conceptualisation of clinical reasoning has insofar been extrapolated from cognitive psychological theories that have been developed in other areas of human decision-making. Till date, the prevailing model of understanding clinical reasoning has remained as the dual process theory which views cognition as a dichotomous two-system construct, where intuitive thinking is fast, efficient, automatic but error-prone, and analytical thinking is slow, effortful, logical, deliberate and likely more accurate. Nonetheless, we find that the dual process model has significant flaws, not only in its fundamental construct validity, but also in its lack of practicality and applicability in naturistic clinical decision-making. Instead, we herein offer an alternative Bayesian-centric, intuitionist approach to clinical reasoning that we believe is more representative of real-world clinical decision-making, and suggest pedagogical and practice-based strategies to optimise and strengthen clinical thinking in this model to improve its accuracy in actual practice.

Keywords: diagnostic error; clinical reasoning; bias; noise; Bayesian model; intuitionist model
Corresponding author: Dr. Isaac KS Ng, MBBS, MRCP (UK), Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore, E-mail:

  1. Research ethics: Not applicable.

  2. Author contributions: IKSN wrote the manuscript draft. IKSN and TKL conceived the study idea. WGWG and TKL edited and critically reviewed the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Informed consent: Not applicable.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: Not applicable.

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Received: 2024-10-16
Accepted: 2024-11-18
Published Online: 2024-12-10

© 2024 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Pioneering diagnosis in Asia: advancing clinical reasoning expertise through the lens of 3M
  4. Short Communication
  5. The foundations of the diagnostic error movement: a tribute to Eta Berner, PhD
  6. Reviews
  7. Interventions to improve timely cancer diagnosis: an integrative review
  8. Technical aspects and clinical applications of synthetic MRI: a scoping review
  9. Mini Review
  10. Challenges and barriers for the adoption of personalized medicine in Europe: the case of Oncotype DX Breast Recurrence Score® test
  11. Opinion Papers
  12. Beyond thinking fast and slow: a Bayesian intuitionist model of clinical reasoning in real-world practice
  13. Diagnostic scope: the AI can’t see what the mind doesn’t know
  14. Guidelines and Recommendations
  15. CDC’s Core Elements to promote diagnostic excellence
  16. Original Articles
  17. Trends of diagnostic adverse events in hospital deaths: longitudinal analyses of four retrospective record review studies
  18. The effect of a provisional diagnosis on intern diagnostic reasoning: a mixed methods study
  19. On context specificity and management reasoning: moving beyond diagnosis
  20. Diagnostic errors in patients admitted directly from new outpatient visits
  21. Breaking the guidelines: how financial unawareness fuels guideline deviations and inefficient DVT diagnostics
  22. Harbingers of sepsis misdiagnosis among pediatric emergency department patients
  23. Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study
  24. Prenatal diagnostic errors in hemoglobin Bart’s hydrops fetalis caused by rare genetic interactions of α-thalassemia
  25. Screening fasting glucose before the OGTT: near-patient glucometer- or laboratory-based measurement?
  26. Three-way comparison of different ESR measurement methods and analytical performance assessment of TEST1 automated ESR analyzer
  27. Short Communications
  28. Medical language matters: impact of clinical summary composition on a generative artificial intelligence’s diagnostic accuracy
  29. Impact of meta-memory techniques in generating effective differential diagnoses in a pediatric core clerkship
https://doi.org/10.1515/dx-2024-0169
Keywords for this article
diagnostic error; clinical reasoning; bias; noise; Bayesian model; intuitionist model

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Pioneering diagnosis in Asia: advancing clinical reasoning expertise through the lens of 3M
  4. Short Communication
  5. The foundations of the diagnostic error movement: a tribute to Eta Berner, PhD
  6. Reviews
  7. Interventions to improve timely cancer diagnosis: an integrative review
  8. Technical aspects and clinical applications of synthetic MRI: a scoping review
  9. Mini Review
  10. Challenges and barriers for the adoption of personalized medicine in Europe: the case of Oncotype DX Breast Recurrence Score® test
  11. Opinion Papers
  12. Beyond thinking fast and slow: a Bayesian intuitionist model of clinical reasoning in real-world practice
  13. Diagnostic scope: the AI can’t see what the mind doesn’t know
  14. Guidelines and Recommendations
  15. CDC’s Core Elements to promote diagnostic excellence
  16. Original Articles
  17. Trends of diagnostic adverse events in hospital deaths: longitudinal analyses of four retrospective record review studies
  18. The effect of a provisional diagnosis on intern diagnostic reasoning: a mixed methods study
  19. On context specificity and management reasoning: moving beyond diagnosis
  20. Diagnostic errors in patients admitted directly from new outpatient visits
  21. Breaking the guidelines: how financial unawareness fuels guideline deviations and inefficient DVT diagnostics
  22. Harbingers of sepsis misdiagnosis among pediatric emergency department patients
  23. Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study
  24. Prenatal diagnostic errors in hemoglobin Bart’s hydrops fetalis caused by rare genetic interactions of α-thalassemia
  25. Screening fasting glucose before the OGTT: near-patient glucometer- or laboratory-based measurement?
  26. Three-way comparison of different ESR measurement methods and analytical performance assessment of TEST1 automated ESR analyzer
  27. Short Communications
  28. Medical language matters: impact of clinical summary composition on a generative artificial intelligence’s diagnostic accuracy
  29. Impact of meta-memory techniques in generating effective differential diagnoses in a pediatric core clerkship
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