Healthcare and Medicine Reference
judgment. 14 It goes beyond gut feeling: Decisions are made on the basis
of hypothetico-deductive thinking, from major a priori formulated clues
to the most probable diagnosis and treatment of possible problems. If a
patient develops a fever after a kidney transplant, it may be equally due
to an infection or rejection of the organ. In the case of an erroneous
diagnosis, antibiotics would not prevent organ rejection with its possible
fatal consequences for the patient, but immunosuppression would not
help in the case of an infection. In such situations, a “steepest ascent
type of thinking” 15 is mandatory.
3. The Gestalt or pattern recognition method is useful in other situa-
tions and allows for appropriate “right” decision making. A patient with
nocturnal distress and dyspnea, who sleeps on several pillows and
holds the bed frame with both hands “to breathe better,” exhibits a pat-
tern suggesting cardiac insufficiency.
4. When competing health conditions are at stake, two decisions can be
considered. In a “minimax” approach, a solution is sought, which would
give a minimum probability of a maximum loss. In a situation of a
possible streptococcal infection of the throat, without the possibility of
laboratory testing, a clinician may decide to prescribe antibiotics to pre-
vent any late systemic complications (maximum loss) of this infection.
In a “maximin” or “Las Vegas approach,” decisions are made to reach a
maximum probability of a minimal loss. In cancer medicine, a chemo-
therapeutic or physical agent leading to fewer secondary effects in cases
of competent efficacy is often chosen for treatment.
5. Decisions are made on the basis of the magic of numbers. Is something
which is “statistically highly significant” always better? How much and
in what practical terms?
6. Heuristic decision making happens in extremis of restraining and
constricting conditions of emergency, 16 crisis, or threat whatever their
cause and reason might be. It may often be a kind of black box
decision making for which reasoning mechanisms must still be ana-
lyzed and better understood. This kind of “rule of thumb” decision
making is well known to all clinicians. It may lead to both right and
7. Other shortcut decisions, most often without detectable heuristics,
Reaction as an immediate response bypassing the cortical decision centers
Conditioning as a preprogrammed reaction based on past experience