clinical reasoning in the real world is mediated by bounded rationality implications for diagnostic clinical practice guidelines临床推理在现实世界中是由有限理性对诊断临床实践指南.pdfVIP

Clinical Reasoning in the Real World Is Mediated by Bounded Rationality: Implications for Diagnostic Clinical Practice Guidelines 1,5 1 2,5 2,5 Ana Paula Ribeiro Bonilauri Ferreira , Rodrigo Fernando Ferreira , Dimple Rajgor , Jatin Shah , Andrea Menezes3, Ricardo Pietrobon2,4,5* 1 Univille, Joinville, Brazil, 2 Duke-NUS Graduate Medical School, Singapore, Singapore, 3 Hospital Angelina Caron, Curitiba, Brazil, 4 Duke University Health System, Durham, North Carolina, United States of America, 5 Research on Research group, Duke University, Durham, North Carolina, United States of America Abstract Background: Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. Method: This is a qualitative study evaluating transcriptions of sixteen physicians’ reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. Results: Four main themes were identified: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of co