Clinical decision making is a complex process that is part art and part science. Although there is no one correct method, it can be helpful to think about your approach so you can refine it as needed to improve patient care.
Author Donald (Raj) R. Woolever, MD, offers the following four-step approach, essentially a modified scientific method:
1. Determine your probabilities. Based on the patient’s symptoms, history, etc., what is the likelihood of a particular diagnosis? For example, if a patient presents with a fever, productive cough, and decreased appetite, your initial hypothesis might be pneumonia, bronchitis, or an upper respiratory infection.
2. Gather data by further evaluating the patient. This usually requires additional history, vital signs, and a physical exam, which will help you confirm or reject your hypothesis.
3. Update your probabilities based on the data you’ve gathered. This includes the pre-test probability of any test you may want to order. Then, carefully collect and interpret additional data from diagnostic tests. The most probable diagnosis should begin to emerge at the top of your differential diagnosis list.
4. Consider an intervention to see whether it crosses your treatment threshold. The larger the therapeutic benefit is relative to the potential harm, the lower the threshold. If you don't have enough information to convince yourself to cross the threshold, consider other options, which may include gathering additional data or watchful waiting.
Adapted from "The Art and Science of Clinical Decision Making."
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Posted on Aug 03, 2018 by FPM Editors
FAQs
Once you have a general idea of how you make decisions, follow these four steps to make the most effective decision possible:
- Define the problem or need: ...
- Analyze the issue at hand: ...
- Implement and communicate: ...
- Learn from the process and the outcome:
A four-step approach to clinical decision making
- Determine your probabilities. ...
- Gather data by further evaluating the patient. ...
- Update your probabilities based on the data you've gathered. ...
- Consider an intervention to see whether it crosses your treatment threshold.
Step 4: Evaluate the identified alternatives
As you evaluate each alternative, identify the likely positive and negative consequence of each. It is unusual to find one alternative that would completely resolve the problem and is significantly better than all others.
What is the clinical approach to decision-making? ›
Clinical decision making refers to the process of constructing clinical options based on objective clinical data and evidence-based standards, with consideration of multiple factors such as patient preferences and technological advancements in healthcare.
What are the 4 approaches to decision-making? ›
We will cover four decision-making approaches starting with the rational decision-making model, moving to the bounded rationality decision-making model, the intuitive decision-making model, and ending with the creative decision-making model.
What are 4 types of decision-making process? ›
Decision making is the selection of a procedure to weigh alternatives and find a solution to a problem. The four styles of decision-making are directive, conceptual, analytical, and behavioral options. Every leader has a preference of how to analyze a problem and come to a solution.
What are the 4 elements of decision making? ›
Much of our success as decision makers depends on our ability to define the four basic elements that make up any decision situation: objectives, alternatives, uncontrollable variables, and parameters. Objectives are the reasons why we decide and are defined by the future state we hope to reach.
What are the 4 levels of medical decision making? ›
The levels of E/M services recognize four types of medical decision making (straight-forward, low complexity, moderate complexity, and high complexity).
What are the 4 principles of decision making? ›
In life there are essentially four decision making principles that give us an idea about how much influence we can have in different situations. These four principles are: Given, Input, Negotiate and Self.
What are the 4 parts of the decision making model? ›
There are 4 basic elements in decision theory: acts, events, outcomes and payoffs.
4 Key Components of Effective Decision Making for Leaders
- Identify the Problem—Then Simplify It. ...
- Embrace the Pre-Mortem. ...
- Welcome the Pivot. ...
- Think Differently.
Figure 2 describes decision making as a four-stage process: intelligence, design, choice and implementation. Intelligence consists of identifying and understanding the problem occurring in the power plants. ...
What are the approaches to clinical decision-making? ›
Evidence-based approaches: using available evidence and best practice guidelines as part of the decision making process. Team work: using the gathered evidence to enlist help, support and advice from colleagues and the wider multi-disciplinary team.
What are the four key stages of decision-making in healthcare? ›
Patients must be able to (1) demonstrate understanding of the benefits and risks of, and the alternatives to, a proposed treatment or intervention (including no treatment); (2) demonstrate appreciation of those benefits, risks, and alternatives; (3) show reasoning in making a decision; and (4) communicate their choice.
What is the four topics approach in clinical ethical decision-making? ›
In terms of ethical decision making, every clinical case, when seen as an ethical problem, may be analyzed by means of four topics: medical indications, patient preferences, quality of life, contextual features.
What are the 4 elements of decision-making? ›
Much of our success as decision makers depends on our ability to define the four basic elements that make up any decision situation: objectives, alternatives, uncontrollable variables, and parameters. Objectives are the reasons why we decide and are defined by the future state we hope to reach.
What are the 4 principles of decision-making? ›
In life there are essentially four decision making principles that give us an idea about how much influence we can have in different situations. These four principles are: Given, Input, Negotiate and Self.
What are the 4 factors of decision-making? ›
The process of making decisions in organizations is determined by various factors: economic, social, organizational, personal and psychological.
