We know very little about how clinicians should, or do, make decisions. Most theories support the existence of “fast” (intuitive) and “slow” (reflective) thinking in most cases. In the study by Schmidt et al, internal medicine residents were more likely to make a diagnostic error on a “paper” case if they had previously read a Wikipedia entry about a superficially similar illness. This tendency was eliminated if they were then asked to go through a step-wise process listing signs and symptoms supporting and not supporting their initial diagnosis. This would argue that reflective thinking is somewhat superior. In the study by Norman, two cohorts of residents answered the same set of case questions under two different sets of instructions: Speed (“as quickly but as accurately as possible”), or Reflect (“may spend as much time as you wish”). There was no difference in the accuracy of the residents’ answers in this study, suggesting the reflective thinking was not superior. -Laura Willett, MD
Croskerry P, Petrie DA, Reilly JB, Tait G. Deciding About Fast and Slow Decisions. Acad Med. 2013 89(2), February 2014, p 197–200.