Critical Thinking, Questioning Yourself, and Clinical Medicine

 

What is critical thinking and how does it apply to these 3 scenarios?

A nurse walks over to communicate a minor, patient inquiry to a physician who is sitting, brow wrinkled, focused, deep in thought, and contemplating the next step in another patient’s care. The nurse interrupts his train of thought, because “protocol says I have to inform the physician when the patient makes these kinds of requests”.

An intern orders hepatic function tests on every patient with abdominal pain regardless of the pain’s exact location, because “that’s how we do it here.”

An experienced physician orders a chest x-ray for every admission even if the patient’s symptoms do not include the chest, because “that’s the way I was trained and that’s the way I’ve practiced it for years.”

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We all fall into old, familiar patterns. Most of the time these patterns serve us well. However, following our familiar patterns is occasionally dysfunctional or wasteful, like in the examples above.

A healthy practice is from time to time to question how and why we do things. This will help improve ourselves and the care of our patients. Ask yourself, “Why do I do what I do?” and “Is there another way to do this that might be better?”

Questioning yourself is applied critical thinking. Many, definitions and applications of critical thinking exist. However, one underlying concept is to question the assumptions that are behind your practices. In doing this, you can test your idea. It is as if you run the idea through a mental stress test to see if it withstands the stress. Your practice may very well be a reasonable way to get things done. However, if your practice does not hold up to the stress of a particular circumstance, then maybe you need to revisit how you do things to see where you need to adjust.

Questioning your own processes takes humility and most people do not like the possibility of being humbled by being wrong. However, if you are able to question yourself with honesty, you will improve yourself and your practice.

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Applying some critical thinking questions to the above 3 scenarios:

The nurse may ask, ”Is this the best way the protocol should be applied in this situation?”

The intern may ask, “Will the hepatic function tests help in this patient’s case?”

The experienced physician may ask, “Is the pre-admission x-ray necessary in every admission?”

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Arguably, the most important part of critical thinking is taking the first step and asking the question. It’s simple in concept, challenging to carry out, rewarding when you do it, and becomes easier with practice.

If you are interested in learning more about critical thinking in medical decision making or other, related topics, please check out my book: A Guide to Clinical Decision Making