Types of Approach
Protocol / pattern based approach (T1 thinking)
Practical / Pragmatic approach (T2 thinking)
Daniel Kahneman in his book – ‘Thinking, Fast and Slow’ talks about Type 1 (T1) & Type 2 (T2) thinking. T1 is automatic & reflexive thinking without conscious effort such as diagnosing a simple UTI, sepsis or AF. T2 is analytical & logical thinking with conscious efforts such as assessing weakness or hyponatraemia.
Both types of thinking is needed in clinical practice. The good clinician is not one who uses more of T1 or T2 but knows when to effectively alternate between the two dependent on the context.
Of course, as we develop as clinicians, more of medicine becomes T1 (the complex becomes simpler). For the purposes of ‘The Acute Mind’ we will primarily focus on T2 with CR techniques.
Consider the following cases as examples of T1 & T2 thinking:
25 year old lady presents to SDEC with a vagal sounding syncope
Protocol / pattern approach = discharge with safety netting
Practical approach = notice the RBBB & T-wave inversions & organise Cardiology investigations
75 year old gentleman with a simple UTI
Protocol / pattern approach = discharge with oral antibiotics
Practical approach = over-investigate the causes of a raised CRP and abdominal discomfort with CT, autoimmune screen etc.
85 year old gentleman admitted with D&V with AKI 3 & CRP 400
Protocol / pattern approach = immediate CT AP
Practical / pragmatic approach = recognition of advanced frailty & dementia with multiple organ co-morbidities hence decision not to investigate following NOK discussion.
The Acute Mind 