How Clinical Decisions Are Made
Open accessAbstract
There is much variation in the implementation of the best available evidence into clinical practice. These gaps between evidence and practice are often a result of multiple individual decisions. When making a decision, there is so much potentially relevant information available, it is impossible to know or process it all (so called ‘ bounded rationality ’). Usually, a limited amount of information is selected to reach a sufficiently satisfactory decision, a process known as satisficing . There are two key processes used in decision making: System 1 and System 2. System 1 involves fast, intuitive decisions; System 2 is a deliberate analytical approach, used to locate information which is not instantly recalled. Human beings unconsciously use System 1 processing whenever possible because it is quicker and requires less effort than System 2. In clinical practice, gaps between evidence and practice can occur when a clinician develops a pattern of knowledge, which is then relied on for decisions using System 1 processing, without the activation of a System 2 check against the best available evidence from high quality research. The processing of information and decision making may be influenced by a number of cognitive biases, of which the decision maker may be unaware. Interventions to encourage appropriate use of System 1 and System 2 processing have been shown to improve clinical decision making. Increased understanding of decision making processes and common sources of error should help clinical decision makers to minimize avoidable mistakes and increase the proportion of decisions that are better .
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In clinical settings, clinicians often tackle tasks using System 1 thinking, particularly in time-sensitive or high-pressure situations.
“In clinical settings, clinicians often tackle tasks using System 1 thinking, particularly in time-sensitive or high-pressure situations [91].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [91]
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Supporting Decision-Making Through Technology
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- Authors
- Bate, L., Hutchinson, A., Underhill, J., & Maskrey, N.
- Affiliations
- National Institute for Health and Care Excellence (GB)
- Corresponding author
- Bate, Louise
- ORCID
- Maskrey, Neal
- Venue
- British Journal of Clinical Pharmacology
- Publisher
- Wiley
- Published
- 2012-09-05
- Volume
- 74
- Issue
- 4
- Pages
- 614-620
- ISSN
- 0306-5251 (ISSN-L)
- 1365-2125
- PMC
- PMC3477329
- OpenAlex
- W1599764279
- Cited by
- 131
- References
- 32
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 11 · 2023: 18 · 2022: 12 · 2021: 7 · 2020: 12 · 2019: 9 · 2018: 12 · 2017: 5 · 2015: 13 · 2014: 3 · 2013: 4 · 2012: 1
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- British Journal of Clinical Pharmacology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Keywords
- clinical decision-making, knowledge-practice gap, bounded rationality, satisficing, cognitive biases, clinical reasoning, decision errors, implementation of evidence
- MeSH terms
- Clinical Competence, Decision Making, Humans, Models, Psychological, Evidence-Based Medicine
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