Thinking and Reasoning in Medicine

Medical reasoning describes a form of qualitative inquiry that examines the cognitive (thought) processes involved in making medical decisions. Clinical reasoning, medical problem solving, diagnostic reasoning, and decision-making are all terms used in a growing body of literature that examines how clinicians make clinical decisions. Medical cognition refers to studies of cognitive processes, such as perception, comprehension, decision making, and problem solving in medical practice itself or in tasks representative of medical practice. These studies use subjects who work in medicine, including medical students, physicians, and biomedical scientists. The study of medical reasoning has been the focus of much research in cognitive science and artificial intelligence in medicine. Medical reasoning involves an inferential process for making diagnostic or therapeutic decisions or understanding the pathology of a disease process. On the one hand, medical reasoning is basic to all higher-level cognitive processes in medicine such as problem solving and medical text comprehension. On the other hand, the structure of medical reasoning is itself the subject of considerable scrutiny. For example, the directionality of reasoning in medicine has been an issue of considerable controversy in medical cognition, medical education and artificial intelligence in medicine. Conventionally, we can partition medical reasoning into clinical and biomedical or basic science reasoning. These are some of the central themes that constitute this chapter. Medical cognition is a subfield of cognitive science devoted to the study of cognitive processes in medical tasks. Studies of medical cognition include analyses of performance in " real-world " clinical tasks as well as in experimental tasks. Understanding the thought processes involved in clinical reasoning in order to promote more effective practices has been the subject of concern for nearly a century (Osler, 1906). Human information processing research has typically focused on the individual. The dual focus on in-depth task analysis and on the study of human performance is a central feature of a cognitive science approach. There have been two primary approaches to research investigating clinical reasoning in medicine: the decision-analytic approach and the information-processing or problem-solving approach. Decision analysis uses a formal quantitative model of inference and decision-making as the standard of comparison (Dowie and Elstein, 1988). It compares the performance of a physician with the mathematical model by 2 focusing on reasoning " fallacies " and biases inherent in human clinical decision-making (Leaper et.al 1972). In contrast, the information-processing approach focuses on the description of cognitive processes in reasoning …