ArticlePloS one2010
Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines.
Article in PloS one, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Evidence in clinical reasoning: a computational linguistics analysis of 789,712 medical case summaries 1983-2012.BMC medical informatics and decision making · 2015Pooled it
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- Transforming clinical reasoning-the role of AI in supporting human cognitive limitations.Frontiers in digital health · 2025Review
- Medical reasoning in LLMs: an in-depth analysis of DeepSeek R1.Frontiers in artificial intelligence · 2025Article
- Reasoning like a doctor or like a nurse? A systematic integrative review.Frontiers in medicine · 2023Review
- Clinical reasoning in traditional medicine exemplified by the clinical encounter of Korean medicine: a narrative review.Integrative medicine research · 2021Review
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- Models of clinical reasoning with a focus on general practice: A critical review.Journal of advances in medical education & professionalism · 2017Article
- What's new in critical illness and injury science? Preventing surgical infections requires the right antibiotic for the right duration.International journal of critical illness and injury science · 2012Article
- Stereotyping of medical disability claimants' communication behaviour by physicians: towards more focused education for social insurance physicians.BMC public health · 2010Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLittle 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.
methodThis 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.
resultsFOUR 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 contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. DISCUSSION: Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration.
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