Thinking About Thinking

Why do some clinicians make better decisions than others? Do all clinicians become better decision-makers over time? Is decision-making in healthcare an independent and trainable skill? This book is about the practice of medicine and the decision-making of the people we entrust with our care. While treatments, technologies and professional roles have evolved over the years, the essential act of decision-making has remained constant. Through personal experience, research and feedback from colleagues across healthcare, the authors examine how metacognition - or thinking about thinking - can provide a toolkit with which to improve the decision-making of all healthcare professionals. The rise of digital tools and AI-based clinical support systems makes this a critical time to grasp how human decision-makers operate and how to best harness the increasing volume of healthcare data available. This is a thought-provoking read for professionals and curious minds alike, packed with ideas and practical advice about how to improve decision-making in healthcare and deliver better outcomes for patients.

Dr Yang Chen completed medicine as an undergraduate at both Cambridge and Oxford University. He has been a Specialist Registrar in Cardiology since 2017 and was awarded a NIHR Academic Clinical Fellowship at University College London. Yang has a passion for medical writing with a track record of publication across different subject matter and styles. His previous work has received national recognition (Royal College of Physicians Teale Essay Prize 2016) and he has published academic papers that have contributed to international guidelines. Yang was a contributor to Clinical Guide to Cardiology (Wiley Publishing, 2015) and was subsequently co-editor of Clinical Guide to Gastroenterology (Wiley Publishing, 2018). His most recent writing has been published by BMJ Leader and the Faculty of Medical Leadership and Management and he is currently completing a PhD in computerised decision support and pragmatic clinical trials at the UCL Institute of Health Informatics. Dr Myura Nagendran is a Specialist Registrar and Fellow of the Faculty of Intensive Care Medicine. He graduated from Cambridge and Oxford Universities and is due to complete his postgraduate clinical training in London in 2025. Myura has published over 50 peer-reviewed papers in journals including the BMJ, Lancet and Nature Medicine and his work has been featured by Fortune and BBC World. He is currently completing a PhD at Imperial College London focused on clinical AI and the evaluation of explainability in high fidelity simulation settings. He has also served on international guideline committees for the surgical treatment of AF (2013) and early-stage AI-driven decision support evaluation (2022).

Prologue Part 1 - Context, Objectives, Chapter 1 Introduction, Chapter 2 Healthcare now, Summary, Part 2 - The Wrong Kind of Training, Objectives, Chapter 3 Old foundations, Chapter 4 Assessment for assessment's sake, Chapter 5 See one, do one, teach one, Summary, Part 3 - How Decisions are Currently Made, Objectives, Chapter 6 Anatomy of a decision, Chapter 7 Common biases, Chapter 8 Process versus outcome, Chapter 9 A prescription for better decisions, Chapter 10 The Nightingale experience, Summary, Part Four - How Decisions will be Made in the Future, Objectives, Chapter 11 How decisions will be made in the future, Chapter 12 Two black boxes, Chapter 13 Care in the future, Summary, Epilogue