The “Yellow Flags” of the Clinician: Reasoning, Reflection and Responses

In this week’s Clinical Insight we shine a light on how we as clinicians can construct the psychological and emotional barriers that may negatively affect patients in their recovery, but perhaps fail to consider these as “thought faults” within our own clinical reasoning.

Stress 

Let’s firstly consider stress. Stress in some cases can cause alertness, vigilance and pace of thinking but overtly may lead to a lack of logicality, rationalisation and clarity. Therefore, as clinicians how do we understand the decisions we might make under higher levels of stress in terms of criticality and confidence?

Reflection will be essential here, but within that reflective model we may in practice need to ascertain our own emotional barriers that could be at play before reflecting on our objectivity in the patient assessment.

Anxieties Around Practice 

Secondly, anxieties around practice, making the right decision, not missing things and ensuring we have covered all bases could lead to a practice anxiety, which in the same way as patients, can lead to over-vigilance and restrictions to freedom to think, which can limit the management of complexity rather than enhance it.

Cognition is not separate from emotion, and the two intertwine via the adaptable clinician. Cognition is tiring as we deal with the amount of information offered to us as clinicians, and those with less experience may have to focus in a different way. Therefore, even the time of day, the type of day and overall, how we are feeling, will potentially affect our reasoning skills.

Social Factors 

Our social factors can also affect our reasoning. Many name this a bias, but essentially our social perspectives, values and experiences will affect how we interact, gain knowledge from the patient narrative, and of course influence our interpretation.

Our own physical stresses that we deem as emotional will of course impact reasoning physically. Heightened awareness manifesting as heart rate change, increasing sweat and breathing rates will all lead to that “feeling” of anxiety, and of course this can become associated with a certain presentation or condition.

This might happen if a clinician had a negative experience with a similar presentation in the past, and this can then “tag” itself and lead to a raised consciousness in the clinician, which may enhance or negatively affect the outcome.

It is vital as reasoning, reflecting clinicians that we consider our own “clinician yellow flags” before we even think about the equivalence within the patient story

References 

Bar, M., 2009. The proactive brain: memory for predictions. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1521), pp.1235-1243.

Brosch, T., Scherer, K., Grandjean, D. and Sander, D., 2013. The impact of emotion on perception, attention, memory, and decision-making. Swiss medical weekly, 143(1920), pp.w13786-w13786.