What Is Clinical Decision-Making?

Looking back at my first year of being a physical therapist and comparing it to today, I can definitely say that my strategies for clinical decision-making have evolved. I can attribute it to my past experiences in the field and the wealth of knowledge that I gained from working with other members of the healthcare team as well as the numerous CE classes that I have attended in the past. When I first started with geriatric home care (after leaving the SNF setting), my initial evaluation would take forever to finish. It only made sense because everything was new - from the patient’s environment, the information needed to be gathered, and of course, the patients themselves. I was trying to get all available information to allow me to reach

The one that struck me the most because of its similarity on how I go about clinical decision-making in my practice is the use of heuristics. A heuristic is an approach of decision-making that uses instincts and short cuts when making clinical decisions (Croskerry, 2005). It puts emphasis on the most relevant information amongst all the data gathered while disregarding the rest (Marewski & Gigerenzer, 2012). This process of taking in the most important data/predictor and weeding out the rest of unnecessary information is like my way of updating my data

A clinical prediction rule (CPR) is an assessment tool developed to help the clinician in diagnosing, predicting treatment outcomes and prognosis by combining data from history taking and physical evaluation (Haskins, Osmotherly, & Rivett, 2015). It can help us make important decisions right then and there without wasting time and resources – the same way heuristics and algorithms help physicians make a decision in clinics/hospitals. Some of these CPR’s, such as the Wells DVT criteria, are widely accepted. Some of them, such as the numerous CPR’s for clinical management of low back pain, still require validation (Haskins et al., 2015). Knowing how heuristics in medicine can be influenced by cognitive biases and thus mislead the practitioner, I fear that using some of these CPR’s could also lead to us leaving out pertinent information and becoming biased with our diagnosis and choice of treatment. This, I believe, is detrimental to our practice especially since we are aiming to become an autonomous