Opening the black box of clinical judgment—an overview

In all advanced healthcare systems, medical decision making depends on cognitive inputs from highly trained doctors. Yet those cognitive inputs fall short of what the practice of medicine requires. The reason is that doctors are expected to do the impossible—firstly, to recall and process complex information reliably under severe time constraints, and then to identify the decisions that patients would make for themselves were they fully informed. The inevitable outcome is that doctors' decisions too often cannot be justified in light of available knowledge, medical risk, cost, benefit, or patients' desires.

The impossible is expected of doctors because we are socialised to rely on their acquired knowledge and cognitive abilities. But cognitive psychology has shown that the human mind normally functions by oversimplifying and filtering complex information. In contrast, modern electronic tools, if properly designed, can empower the mind to systematically consider all available details and their possible combinations. A new division of intellectual labour in medicine is therefore possible—a division between electronic tools that retrieve and process information, and users who apply judgment and values to arrive at medical decisions.