ABC of Clinical Reasoning
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Being a good clinician is not just about knowledge – how doctors and other healthcare professionals think, reason and make decisions is arguably their most critical skill. While medical schools and postgraduate training programmes teach and assess the knowledge and skills required to practice as a doctor, few offer comprehensive training in clinical reasoning or decision making. This is important because studies suggest that diagnostic error is common and results in significant harm to patients – and errors in reasoning account for the majority of diagnostic errors.

The ABC of Clinical Reasoning covers core elements of the thinking and decision making associated with clinical practice – from what clinical reasoning is, what it involves and how to teach it. Informed by the latest advances in cognitive psychology, education and studies of expertise, the ABC covers:

  • Evidence-based history and examination
  • Use and interpretation of diagnostic tests
  • How doctors think – models of clinical reasoning
  • Cognitive and affective biases
  • Metacognition and cognitive de-biasing strategies
  • Patient-centred evidence based medicine
  • Teaching clinical reasoning

From an international team of authors, the ABC of Clinical Reasoning is essential reading for all students, medical professionals and other clinicians involved in diagnosis, in order to improve their decision-making skills and provide better patient care.


Nicola Cooper is Consultant Physician and Honorary Clinical Associate Professor, Derby Teaching Hospitals NHS Foundation Trust, and Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK

John Frain is General Practitioner and Director of Clinical Skills, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK


Contributors vi

Preface vii

1 Clinical Reasoning: An Overview 1
Nicola Cooper and John Frain

2 Evidence-Based History and Examination, 6
Steven McGee and John Frain

3 Using and Interpreting Diagnostic Tests 12
Nicola Cooper

4 Models of Clinical Reasoning 17
Martin Hughes and Graham Nimmo

5 Cognitive Biases 22
Nicola Cooper

6 Human Factors 27
Nicola Cooper

7 Metacognition and Cognitive Debiasing 33
Pat Croskerry

8 Using Guidelines, Scores and Decision Aids 39
Maggie Bartlett and Simon Gay

9 Teaching Clinical Reasoning 44
Nicola Cooper, Ana L. Da Silva and Sian Powell

Recommended Books, Articles and Websites 51

Index 53


"Sound decision making is routinely cited as a cornerstone of clinical practice. But what techniques actually underlie this process, and why does it all too often go wrong? The answers to these questions, and more, are provided by the authors of this book, who have successfully compressed the burgeoning subject of clinical reasoning into a succinct and easily accessible textbook...

The text attempts to cover a lot of ground for such a slim volume and occasional sections seem a little cramped. The overall effect, though, is to enthusiastically and intelligently convey the importance of a so far underappreciated yet vital aspect of clinical practice.

Readers should not expect this text to provide a complete summary of the subject (a comprehensive bibliography is supplied). Nor should they expect a single reading to provide an instant remedy to deficiencies in their own decision making because, as the editors state, developing sound clinical reasoning is a lifelong task. With that in mind, picking up this book would make an excellent start."(BJGP Open, 24th February 2017)