Clinical Decision Making: An Emergency Medicine Perspective

Authors

  • George Kovacs MD, MHPE,

    Corresponding author
    1. Divisions of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia
    2. Divisions of Medical Education, Dalhousie University, Halifax, Nova Scotia
    3. Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia
    Search for more papers by this author
  • Pat Croskerry MD, PhD

    1. Divisions of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia
    2. Department of Emergency Medicine, Dartmouth General Hospital, Dartmouth, Nova Scotia, Canada
    Search for more papers by this author

***Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, 1796 Summer Street, Halifax, Nova Scotia, Canada, B3H 3A7. Fax: 902-473-3617; e-mail: gkovacs@is.dal.ca

Abstract

Abstract. Clinical decision making (CDM) describes a form of qualitative inquiry that examines the thought processes involved in making medical decisions. A significant body of literature exists on the orderly “hypothetico-deductive” model of clinical decision making. However, very little has been written on how CDM differs in the acute setting. This paper reviews the common methods of CDM and their relevance to emergency medicine (EM). The concept of diagnostic uncertainty and the utility of the diagnosis of unknown etiology in the disposition phase of the emergency patient visit are discussed. Finally, a unique EM perspective on clinical decision-making errors is presented.

Ancillary