Makindo Medical Notes

Decision Making for Doctors: Balancing Intuitive and Analytical Approaches

• Clinical decision making is a fundamental skill for doctors, guiding how they diagnose conditions, plan treatments, and manage patient care.
• Effective decision making often relies on two distinct cognitive processes—commonly referred to as Type 1 and Type 2 thinking.
• Understanding the characteristics, strengths, and vulnerabilities of each can improve diagnostic accuracy and patient outcomes.

Common Cognitive biases

• Overconfidence bias—the tendency to believe we know more than we actually do
• Availability bias—the likelihood of diagnosing recently seen conditions
• Ascertainment bias—seeing what we expect to see
• Confirmation bias—only looking for evidence to support a theory, not to refute it
• Commission bias—the assumption that doing something is better than watchful waiting
• Omission bias—the belief that doing nothing is better rather than causing harm.

The mark of a well-calibrated thinker is the ability to recognise what mode of thinking is being employed and to anticipate and recognise situations in which cognitive biases and errors are more likely to occur.

The Two Systems of Thinking

How These Thinking Systems Apply in Practice

• Type 1 thinking often helps doctors rapidly recognize common clinical patterns. For example, when an experienced physician immediately suspects pneumonia upon hearing a patient’s “bubbly” breath sounds and seeing a fever on presentation, they are using Type 1 thinking. This rapid pattern recognition can be invaluable in emergency situations where timely decisions are critical. However, Type 1 thinking is not without risk. Because it relies heavily on heuristics and prior experience, it can lead to diagnostic errors if an atypical presentation fits a familiar pattern only superficially. Cognitive biases—such as anchoring on a first impression or ignoring conflicting information—are more common with Type 1 thinking.
• Type 2 thinking, on the other hand, is more deliberate and reflective. It involves systematic evaluation of evidence, careful consideration of differential diagnoses, and a more methodical reasoning process. For instance, a doctor relying on Type 2 thinking might systematically go through a diagnostic checklist or use evidence-based guidelines to choose the most appropriate imaging study for a complicated case. While this approach is more time-consuming and mentally demanding, it generally offers greater accuracy and consistency.

Striking a Balance

• In practice, most physicians combine both types of thinking. Skilled clinicians know when to trust their intuitive judgments for routine or classic cases and when to switch to a more analytical mode for complex, ambiguous, or high-stakes decisions.
• Awareness of one’s cognitive processes and potential biases helps doctors refine their approach, improving patient outcomes and minimizing diagnostic error.
• Effective clinical decision making involves understanding when to apply fast, intuitive judgments and when to engage in slower, more structured reasoning. By recognizing the nature, advantages, and pitfalls of both Type 1 and Type 2 thinking, doctors can develop a more flexible and reliable decision-making style that adapts to the needs of each patient scenario.