Clinical reasoning in medicine I: A historical journey

Medical error is a public health problem, that may be related to failures in a doctor’s decision-making about a patient’s diagnosis, treatment, or prognosis, that is, in medical reasoning. Despite its importance, the understanding of clinical reasoning has been heterogeneous, with the use of multiple definitions and theoretical models, which focus on different aspects of the processing that physicians elaborate about taking care of a patient. This conceptual diversity can be explained by the influence of the historical context. How physicians think can be seen from magical thinking in Antiquity, through Renaissance rationalism and the modern scientific approach, to current models of dual thinking and probability estimation. What seems to be constant is that it has an explanatory mission of knowing what happens to the patient, although the ultimate goal is more to understand the patient’s experience. In this narrative review, this evolution is presented with a timeline, which summarizes the ways of conceiving reasoning in medicine according to the historical context.