Types of Clinical Judgment and the Criteria for Good Reasoning

Prognosis is a predictive judgment, while diagnosis and hypotheses about cause are evaluative. Some judgments can be verified against a gold standard or over time through reassessment, but many, such as the exact tissue source in non-specific pain or the precise pain mechanism, cannot. Following Kahneman, Mark argues these must be judged by the quality of the thought process behind them. Good reasoning means a relatively unbiased assessment, a clear purpose for each question and test, enough breadth and depth, and awareness of the assumption Kahneman calls what you see is all there is, countered by screening. Information should be accurate and precise, classifications used correctly, analyses reported with reference to the findings, and relevance judged, since many impairments appear in people without symptoms. He shows how one piece of information informs several judgments. The area of symptoms suggests possible structures, referral sources and pain type, while aggravating and easing factors reveal what is loaded or unloaded, coping strategies, the personal context and clues to psychosocial factors.