Making better clinical decisions: How doctors can recognise and reduce bias and noise in medical practice

Clinical reasoning and decision-making are essential to medical practice, where poor clinical judgement can lead to serious diagnostic errors, suboptimal use of diagnostic tests and investigations, flawed management strategies and ultimately, adverse patient outcomes. It is known that in real-world clinical environments, clinicians often rely on intuitive judgements for decision-making, due to natural proclivities for pattern-recognition and retrieval of pre-existing illness scripts, as well as out of practical necessity to be efficient in fast-paced work environments with high patient volume and cognitive load. Yet, an over-reliance on intuitive judgements can result in cognitive errors. While biases associated with heuristics-based or intuitive thought processes are often discussed in literature, there is also a lesser entity of noise that affects consistency and reliability of clinical decision-making. In this article, we highlight the importance of learning foundational principles of clinical reasoning and understanding how cognitive errors happen in medical training, and suggest a series of educational pedagogies and workplace-based interventions that could help to cultivate and optimise medical decision-making in real-world practice.