Abstract
Cognitive error, innate to all human reasoning, commonly interferes with clinical success. Psychiatric education and practice skew toward the lowest levels of clinical reasoning, leaving practitioners unprepared to solve many of the increasingly complex clinical dilemmas we face. Despite our self-confidence, around half of current treatment attempts result in suboptimal outcomes or overt treatment failures, increasingly mislabeled “treatment resistance.” While methods typically evolve during a career, abductive reasoning with Bayesian inference is the most effective for all levels of experience. Utilizing a collective perspective while obtaining, sharing, and analyzing information in a reflective, nondeterministic, and probabilistic manner leads to the best outcomes; individual clinicians must learn and practice these higher-level thinking skills. By facing our errors and failures, we mature and add to our clinical effectiveness. Results are better when we accept uncertainty and continuously revise our models.
Keywords
Medical Error, Clinical Reasoning, Treatment Failure, Treatment Resistance, Critical Thinking, Metacognition, Hypothetico-deductive, Inductive, Abductive, Bayesian, Eristic, Heuristic, Psychiatry