Reflecting on a Clinical Decision: Subconscious Cues
In this Clinical Insight, we reflect on how a clinical decision is made and the role that subconscious cues play in this.
As clinicians know, clinical reasoning involves the cognitive processes that culminate in a diagnosis and treatment plan. The process itself is difficult to analyse and especially in experts where non-analytic reasoning, which is believed to be mainly subconscious, features as the premise for fast thinking or pattern recognition.
Cognitive expertise involves the linking of information via a set of perceptual cues into a more meaningful pattern. The dual process theory that allows humans to be able to move from fast patterns to slow analytical models is reflected in clinical practice.
Errors in reasoning are clearly commonly experienced and can range across cognitive bias and knowledge gaps. Clinicians can too early anchor a diagnosis, look to confirm it with a less analytical assessment of relevant information, or perhaps premature closure without considering other sources.
The subtly of practice and information can be built on subconscious cues that essentially raise an awareness and a more analytical approach of enquiry. These can be linked to previous experiences, knowledge, or a blend of past encounters that build a picture for the clinician.
Responses can be augmented as physical experiences in the clinician, such as heart rate, sweating or breathing, rather like a mild stress response, if there is concern. Otherwise, it’s a level of conscious confidence that builds as the pattern “fits”.
Clinical Clues
The subtle clinical cues are different for every patient: they can be physical, emotional, verbal, or non-verbal. These can be a way something is explained, the words, phrases, description. It could the way a patient shows where the symptoms are and the words used in conjunction with this to describe it.
The responses to the specific questions, some of course may be evidence based to inform, others just from prior experience. The clinician may enquire in a certain way to see if a familiar response is gained. The way the patient interacts non-verbally will be full of clues to be explored, and in the end analytically accepted or rejected based on clinical relevancy to what might be happening.
Essentially, sub-conscious cues become conscious through analysis, concern, or linking patterns. Clinicians, although looking for “tests” that offer sensitivity / specificity have to be aware of the subconscious to conscious cueing of meaning, and the wax and wane of fast to slow reasoning through the clinical encounter.
By doing so, improved diagnosis and reflection is more likely to be achieved as experience is gained.
This Clinical Insight article is Part Two in our current series – Part One explored the “Yellow Flags” of the Clinician: Reasoning, Reflection and Responses.
References
Corrao, S. and Argano, C., 2022. Rethinking clinical decision-making to improve clinical reasoning. Frontiers in Medicine, 9, p.900543.
van den Berg, B., de Bruin, A.B., Marsman, J.B.C., Lorist, M.M., Schmidt, H.G., Aleman, A. and Snoek, J.W., 2020. Thinking fast or slow? Functional magnetic resonance imaging reveals stronger connectivity when experienced neurologists diagnose ambiguous cases. Brain Communications, 2(1), p.fcaa023.