Conclusions and Future Directions

The process of medical reasoning is one area in which advances in cognitive science have made significant contributions to investigation. In particular, reasoning in medical contexts involving a dense population and a high degree of uncertainty (such as critical care environments), compounded with constraints imposed by resource availability, leads to increased use of heuristic strategies. The utility of heuristics lies in limiting the extent of purposeful search through data sets, which have substantial practical value by reducing redundancy. A significant part of a physician's cognitive effort is based on heuristic thinking, but its use introduces considerable bias in medical reasoning, often resulting in a number of conceptual and procedural errors. These include misconceptions about laws governing probability, instantiation of general rules to a specific patient at the point of care, prior probabilities and actions, and false validation. Much of physicians' reasoning is inductive with attached probability. Human thought is fallible and we cannot appreciate the fallibility of our thinking unless we draw on understanding of how physicians' thinking processes operate in the real working environment.

Cognitive studies are increasingly moving toward investigations of real-world phenomena. The constraints of laboratory-based work prevent capturing the dynamics of real-world problems. This problem is particularly salient in high-velocity critical care environments. In the best-case scenarios, this is creating the potential for great synergy between laboratory-based research and cognitive studies in the "wild." As discussed in this chapter, studies of thinking and reasoning in medicine, including a focus on medical errors and technology-mediated cognition, are increasingly paying attention to dimensions of medical work in clinical settings.

The recent concern with understanding and reducing medical errors provides an opportunity for cognitive scientists to apply cognitive theories and methodologies to a pressing practical problem. A trend in health care, spurred partly by the advent of information technologies that foster communication, is the shift in health-care systems to become increasingly multidisciplinary, collaborative, and geographically spanning regions. In addition, increasing costs of health care and rapid knowledge growth have accelerated the trend toward collaboration of health-care professionals in sharing knowledge and skills. Comprehensive patient care necessitates the communication of healthcare providers in different medical domains, thereby optimizing the use of their expertise. Research on reasoning will need to continue to move toward a distributed model of cognition. This model will include a focus on both socially shared and technology-mediated reasoning.

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