Makindo Medical Notes

Decision Making for Doctors: Balancing Intuitive and Analytical Approaches

• Clinical decision making is a cornerstone of medical practice, shaping how doctors diagnose conditions, plan treatments, and manage patient care.
• It draws on two cognitive systems—commonly referred to as Type 1 (intuitive) and Type 2 (analytical) thinking.
• Understanding the strengths, limitations, and biases of each helps reduce diagnostic error and improve patient outcomes.

Common Cognitive Biases in Clinical Practice

• Overconfidence bias: Overestimating the accuracy of one’s knowledge.
• Availability bias: Diagnosing conditions that come most readily to mind (e.g., recent cases).
• Ascertainment bias: Seeing what we expect to see, rather than what is present.
• Confirmation bias: Looking for evidence to support an initial theory while ignoring contradictory data.
• Commission bias: Acting unnecessarily, assuming intervention is always better than observation.
• Omission bias: Avoiding action, believing doing nothing is safer than risking harm.

The mark of a well-calibrated clinician is recognising which mode of thinking is being used and anticipating when cognitive biases are most likely to occur.

The Two Systems of Thinking

How These Systems Apply in Practice

• Type 1 thinking: Useful for rapid recognition of familiar clinical patterns. Example: a doctor instantly recognising pneumonia from fever, cough, and crackles. However, reliance on heuristics increases risk of errors, particularly in atypical presentations or rare diseases.
• Type 2 thinking: Involves systematic analysis and evidence-based reasoning. Example: using guidelines and stepwise investigation for a patient with unexplained anaemia. It is slower but reduces bias and improves diagnostic accuracy.

Striking a Balance

• Experienced clinicians blend both systems—using intuition for efficiency in routine cases, but deliberately shifting to analytical reasoning when stakes are high or the diagnosis is uncertain.
• Awareness of one’s cognitive biases allows doctors to pause, reflect, and avoid premature closure.
• Developing this flexibility enhances diagnostic accuracy, improves patient safety, and supports high-quality care.