Clinical Reasoning, Clinical Decision Analysis, and Clinical Intuition

The Think No Evil, Do No Evil, Know No Evil of Clinical Practice?

Published in: Topics in Clinical Chiropractic, v. 5, no. 2, June 1998, p. 27-33

Posted on RAND.org on January 01, 1998

by Ian D. Coulter

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During the last 30 years much work has been done in the health professions to understand and teach clinical decision making. This article examines the lessons learned from a chiropractic perspective. A review of the literature is presented that delineates what is known about three aspects of clinical thinking, namely clinical reasoning, decision analysis, and intuition in clinical practice. While formal, quantitative research methods have greatly expanded understanding of clinical reasoning, and decision analysis has provided a method for improving clinical reasoning, tacit knowledge or intuition is also important. Rather than providing a replacement for intuition, the research provides support for the significance of its role, and indirect support for its efficiency. Knowledge and experience are integral processes and crucial to good clinical decision making. This finding poses a challenge to chiropractic education, which is at a disadvantage when it comes to providing clinical experience to its students.

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