Management Reasoning: Beyond the Diagnosis

Cook et al cite that clinical reasoning--the integration of clinical information, medical knowledge, and contextual (situational) factors to make decisions about patient care--is fundamental to medical practice. Poor reasoning is an important cause of medical error; for example, diagnostic errors are thought to contribute to approximately 10% of patient deaths and hospital adverse events. Most research in clinical reasoning has focused on decisions related to diagnosis, ie, diagnostic reasoning. By contrast, management reasoning is primarily a task of prioritization, shared decision making, and monitoring, and is typically more complex. A better understanding of management reasoning could help to expand the current conception of medical error and may offer potential insights regarding error prevention, clinical practice quality improvement, overuse and appropriate use of diagnostic tests, and training and assessment of health professionals.