Clinical reasoning in medicine and nursing: Decision making versus problem solving

Abstract

The clinical reasoning process includes two broad components: (a) problem solving (searching for the one “right”; answer) and (b) decision making (selecting from several possibilities). Each component requires considerable knowledge and skill; decision making also requires that the values assigned to each potential outcome be ascertained and used. We present a framework for the clinical encounter, with particular emphasis on treatment selection. We then note evidence, including three studies conducted by our research group, to support the view that clinical problem solving is based primarily on pattern recognition following data gathering, rather than on a deterministic rule‐based approach. We suggest that a pattern recognition approach, which stresses the importance of a knowledge base as opposed to a set of learned skills, implies a strong potential role for the computer in both medical practice and medical education.