Clinical decisions as problem solving
Clinical decisions can be conceptualized as a form of problem solving and involve the
development of hypotheses early on in the consultation process. These hypotheses are
subsequently tested by the doctor’s selection of questions. Models of problem solving
have been applied to clinical decision making by several authors (e.g. MacWhinney
1973; Weinman 1987), who have argued that the process of formulating a clinical
decision involves the following stages (see Figure 4.3):1 Accessing information about the patient’s symptoms. The initial questions
in any consultation from health professional to the patient will enable the health
professional to understand the nature of the problem and to form an internal repre-
sentation of the type of problem.
2 Developing hypotheses. Early on in the problem-solving process, the health
professional develops hypotheses about the possible causes and solutions to the
problem.
3 Search for attributes. The health professional then proceeds to test the hypotheses
by searching for factors either to confirm or to refute their hypotheses. Research
into the hypothesis testing process has indicated that although doctors aim to
either confirm or refute their hypothesis by asking balanced questions, most of their
questioning is biased towards confirmation of their original hypothesis. Therefore, an
initial hypothesis that a patient has a psychological problem may cause the doctor
to focus on the patient’s psychological state and ignore the patient’s attempt to talk
about their physical symptoms. Studies have shown that doctors’ clinical informationFig. 4-3 Diagnosis as a form of problem solving88 HEALTH PSYCHOLOGY