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dc.contributor.author Ferreira, APRB
dc.contributor.author Ferreira, RF
dc.contributor.author Rajgor, D
dc.contributor.author Shah, J
dc.contributor.author Menezes, A
dc.contributor.author Pietrobon, R
dc.date.accessioned 2011-06-21T17:31:30Z
dc.date.issued 2010
dc.identifier.citation PLoS ONE, 2010, 5 (4)
dc.identifier.issn 1932-6203
dc.identifier.uri http://hdl.handle.net/10161/4536
dc.description.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 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. Copyright: © 2010 Bonilauri Ferreira et al.
dc.language.iso en_US en_US
dc.relation.ispartof PLoS ONE
dc.relation.isversionof 10.1371/journal.pone.0010265
dc.title Clinical Reasoning in the Real World Is Mediated by Bounded Rationality: Implications for Diagnostic Clinical Practice Guidelines
dc.title.alternative en_US
dc.type Journal Article
dc.description.version Version of Record en_US
duke.date.pubdate 2010-4-20 en_US
duke.description.endpage e10265 en_US
duke.description.issue 4 en_US
duke.description.startpage e10265 en_US
duke.description.volume 5 en_US
dc.relation.journal Plos One en_US
pubs.issue 4
pubs.organisational-group /Duke
pubs.organisational-group /Duke/Faculty
pubs.volume 5

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