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The intuitive appeal of case series thinking: a challenge for evidence-based teaching and practice
  1. Joshua J Fenton1,
  2. Khalid S Khan2
  1. 1Department of Family and Community Medicine and the Centre for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
  2. 2Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to Dr Joshua J Fenton, 4860 Y Street, Suite 2300, Sacramento, CA 95817, USA; joshua.fenton{at}

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Time pressures often require highly efficient, intuitive approaches to decision making. On the fly, we depend upon short cuts, or heuristics, to make rapid, efficient decisions. Heuristics are indispensable cognitive processes for quickly solving problems without the formal use of logic and research evidence. Encountering unfamiliar situations, for example, we act based on outcomes of recent similar, memorable or noteworthy experiences (the availability heuristic).1 In light of the flood of data encountered in daily life, such short cuts are unavoidable, but they can also lead to error, such as overestimating the likelihood of a rare event. Physicians, like everybody else, are psychologically predisposed to similar errors in their medical practices.2 Evidence-based practice and teaching requires an awareness of the potential pitfalls of intuitive, heuristically derived clinical decision making and effective strategies for circumventing these pitfalls.

The availability heuristic implies that our personal clinical experiences will invariably influence our clinical reasoning, if not our ultimate decisions. This heuristic, based on recall of items in memory, presents solutions …

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  • Competing interests None.