Clinical Decision Making
December 17, 2019 | Farah Jassawalla

Clinical Decision Making

Clinical decision making is a circumstantial, uninterrupted, and continuously developing a process where data is collected, analyzed, and evaluated in order to choose an evidence-based choice of action. This term is very frequently used in describing the role of nurse practitioners.

Importance of clinical decision making

A huge amount of clinical data is integrated when clinicians face conflicting pressures to decrease the uncertainty in their diagnostic procedures, costs, and the risks that patients are exposed to. Deciding on what kind of information is required, what tests are to be conducted, how to interpret the data, and how to integrate the information in a manner where a conclusion could be determined to treat a certain health issue is known as clinical decision making.
When a clinician is presented with a potential health condition, it is advisable to ask the following questions:
•    What disease/diseases could the patient potentially have?
•    Does the patient require treatment?
•    Is there a need for any tests to be conducted?
Diagnoses are made by identifying the disease patterns and test results, while the treatments are based upon the customary practice of the clinicians. For example, when a flu epidemic is in progress, a healthy individual who has had a harsh cough and fever for about two days is highly likely to be diagnosed as another case of influenza and be provided with only symptomatic relief. This pattern recognition process is easy and efficient, but it has the potential to be erroneous in nature as other diagnostic possibilities are not systematically and seriously considered.

4-steps to follow for clinical decision making

Being a complex process that is part science and part art, clinical decision making does not have a standard method to be followed. Thinking about the approach can help refine the method as per the requirement to ensure improved care for the patient. However, the following steps generally guide you towards the method to be followed (subject to change according to need):
1. Determine the probabilities: After a detailed diagnostic examination of the patient, based on symptoms and past medical history, the likelihood of a specific diagnostic is analyzed. For example, if a patient has decreased appetite, fever, and cough, you might hypothesize the diagnosis to be for pneumonia or an upper respiratory infection.
2. Evaluate the patient to gather more information: This step requires the clinician to ask the patient for additional medical history, a physical examination, and vital signs that help in the diagnosis procedure. This step is crucial in deciding whether the hypothesis of the clinician is to be confirmed or to be rejected.
3. Update the probabilities (step 1) based on the additional data you have gathered in step 2: This step is inclusive of any pretests in order to carefully collect and interpret supplementary data.
4. Consider intervention in order to see whether it crosses the treatment threshold: The threshold is lower when the therapeutic benefit is greater than the potential harm. If the clinician does not have enough information to convince himself to cross the threshold level, he should opt for other options.

Core skills of clinical decision making

The combination of skills, experience, and expertise is necessary for effective and efficient clinical decision making. Some of the most highly valued skills in this field are:
● Recognizing the pattern: learning from past experiences.
● Critical thinking: being skeptical and removing emotions from clouding the judgment.
● Communication skills: active listening is very important as the clinician needs to listen to the patient very closely in order to have a reliable and confident hypothesis.
● Evidence-based approaches: the decision needs to be made on reliable evidence that is from authentic sources such as medical tests.
● Sharing: sharing your decision-making process and getting feedback on it is a helpful tool in realizing any mistakes and avoiding them the next time around.

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Farah Jassawalla
