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首页> 外文期刊>Journal of paediatrics and child health >Fast and slow thinking; and the problem of conflating clinical reasoning and ethical deliberation in acute decision‐making
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Fast and slow thinking; and the problem of conflating clinical reasoning and ethical deliberation in acute decision‐making

机译：快速和慢思考; 以及急性决策中临床推理和伦理思考的问题

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Abstract Expertise in a medical specialty requires countless hours of learning and practice and a combination of neural plasticity and contextual case experience resulting in advanced gestalt clinical reasoning. This holistic thinking assimilates complex segmented information and is advantageous for timely clinical decision‐making in the emergency department and paediatric or neonatal intensive care units. However, the same agile reasoning that is essential acutely may be at odds with the slow deliberative thought required for ethical reasoning and weighing the probability of patient morbidity. Recent studies suggest that inadequate ethical decision‐making results in increased morbidity for patients and that clinical ethics consultation may reduce the inappropriate use of life‐sustaining treatment. Behavioural psychology research suggests there are two systems of thinking – fast and slow – that control our thoughts and therefore our actions. The problem for experienced clinicians is that fast thinking, which is instinctual and reflexive, is particularly vulnerable to experiential biases or assumptions. While it has significant utility for clinical reasoning when timely life and death decisions are crucial, I contend it may simultaneously undermine the deliberative slow thought required for ethical reasoning to determine appropriate therapeutic interventions that reduce future patient morbidity. Whilst health‐care providers generally make excellent therapeutic choices leading to good outcomes, a type of substitutive thinking that conflates clinical reasoning and ethical deliberation in acute decision‐making may impinge on therapeutic relationships, have adverse effects on patient outcomes and inflict lifelong burdens on some children and their families.
机译：医疗专业的摘要专业知识需要无数的学习和实践，以及神经可塑性和语境案例经验的组合，导致高级甲般的临床推理。这一整体思维吸收了复杂的分段信息，是有利于在急诊部和儿科或新生儿重症监护单位中及时的临床决策。然而，与急性急剧的相同敏捷推理可能是良好的思想思想，伦理推理所需的缓慢思想和称重患者发病率的可能性。最近的研究表明，道德决策不足导致患者的发病率增加，临床伦理咨询可能会减少不恰当的生活持续治疗。行为心理学研究表明，有两个思维系统 - 快速和缓慢 - 控制我们的思想，从而控制我们的行为。经验丰富的临床医生的问题是，即本能和反思的快速思维特别容易受到体验偏见或假设的影响。虽然在及时的生命和死亡决策是至关重要的临床推理具有重要效用，但我认为，它可能会同时破坏道德推理所需的审议缓慢思想，以确定降低未来患者发病率的适当治疗干预措施。虽然卫生保健提供者通常具有良好的治疗选择，导致良好的结果，这种替代思想与急性决策中的临床推理和道德审议混合可能会影响治疗关系，对患者成果产生不利影响，并对一些人造成终身负担造成终身负担的不利影响孩子和他们的家人。

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