Books: ABC of Clinical Reasoning: Sound and Rational Decision Making

Ben Norris

doi:10.3399/bjgp17X689737

Nicola Cooper and John Frain Wiley-Blackwell, 2016, PB, 64pp, £24.99, 978-1119059080

Sound decision making is routinely cited as a cornerstone of clinical practice. But what techniques actually underlie this process, and why does it — all too often — go wrong? The answers to these questions, and more, are provided by the authors of this book, who have successfully compressed the burgeoning subject of clinical reasoning into a succinct and easily accessible textbook.

The initial chapters review the main components of clinical decision making. These include a rational, evidence-based appraisal of the utility of history taking, physical examination, and diagnostic testing. Proposed models of clinical reasoning are then outlined, including an illuminating discussion of the application of Kahneman’s theory of type 1 and type 2 thinking in reaching a diagnosis.¹

Real-life examples are used to candidly illustrate the results of flawed clinical reasoning in chapters covering cognitive biases and human factors in decision making, which should have a salutary effect on medical practitioners of all degrees of experience. This section forcefully makes the case for greater consideration of tools to counter these intellectual pitfalls, suggestions of which are presented in the next chapter. These strategies are based on the concept of ‘metacognition’ — thinking about thinking, by which we can identify the blind spots in our own judgements.

The penultimate chapter provides a useful reminder of the values and limitations of guidelines and decision aids, with the final section devoted to methods of teaching clinical reasoning; an appeal that one hopes will be taken up widely.

The text attempts to cover a lot of ground for such a slim volume and occasional sections seem a little cramped. The overall effect, though, is to enthusiastically and intelligently convey the importance of a so far underappreciated yet vital aspect of clinical practice.

Readers should not expect this text to provide a complete summary of the subject (a comprehensive bibliography is supplied). Nor should they expect a single reading to provide an instant remedy to deficiencies in their own decision making because, as the editors state, developing sound clinical reasoning is a ‘lifelong’ task. With that in mind, picking up this book would make an excellent start.