期刊
QUALITATIVE HEALTH RESEARCH
卷 27, 期 6, 页码 866-876出版社
SAGE PUBLICATIONS INC
DOI: 10.1177/1049732316650418
关键词
clinical reasoning; evidence-based medicine; rhetorical theory; socio-narratology; professional culture; medical education; Ontario; Canada; qualitative research
类别
资金
- Royal College of Physicians and Surgeons of Canada Medical Education Grant [14/MERG-04]
- Ontario Ministry of Health and Long-Term Care
According to the dual process model of reasoning, physicians make diagnostic decisions using two mental systems: System 1, which is rapid, unconscious, and intuitive, and System 2, which is slow, rational, and analytical. Currently, little is known about physicians' use of System 1 or intuitive reasoning in practice. In a qualitative study of clinical reasoning, physicians were asked to tell stories about times when they used intuitive reasoning while working up an acutely unwell patient, and we combine socio-narratology and rhetorical theory to analyze physicians' stories. Our analysis reveals that in describing their work, physicians draw on two competing narrative structures: one that is aligned with an evidence-based medicine approach valuing System 2 and one that is aligned with cooperative decision making involving others in the clinical environment valuing System 1. Our findings support an understanding of clinical reasoning as distributed, contextual, and influenced by professional culture.
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