Diagnostic certainty

The difficult path that leads us to understand the concept of probability in clinical practice

Abstract

The purpose of this article is to examine how we make decisions in problematic scenarios. In clinical practice we apply decision rules to estimate degrees of certainty and adapt our behavior. Certainty is a "what to do" in front of perplexity or doubt, with both epistemic and emotional component. The expert knowledge is a knowledge based on criteria that are structured in a probabilistic manner to minimize risk. Most clinical situations end with a concrete risk calculation for this clinical situation and this concrete patient, a calculation requiring cognitive effort. We identified several strategies to simplify this effort, which lead us to higher rates of misdiagnosis, concluding that to delay diagnostics, giving us more  time to think, is one of the fundamental skills of a good clinician.