Judgment and reasoning in professional contexts

Clinical practice is not a simple matter of acquiring knowledge, psycho-motor skills, and unequivocal best-practice rules, and then applying these to neatly framed clinical cases. Rather, it is a complex set of knowledge–judgment– reasoning–practice interactions ranging from micro- to macro- to meta-levels of enactment, from the rapid to the deliberated, and from novice to expert, all embedded in a framework of professional duty of care. In addition, all of this occurs in multiple contexts: the patient’s world, the discipline’s rapidly changing state of practice art and science, the context of accountability and evidence, and the actual organizational setting (with its given resources, standards, systems, and people). In this chapter the topics of judgment and decision making are examined in relation to these practices and contexts and in consideration of task complexity. Such task complexity is epitomized by the focus of this book on the practice of catheter-based cardiovascular interventions where the clinician encounters multiple complex cognitive, metacognitive, psycho-motor, and interpersonal demands, typically under time pressure and with high-level consequences (including accuracy and significance of diagnosis, risk of error in performance and judgment, and potential impact on consequent decisions and the quality of the patient’s life).