REHB1001 Chap.5 Reasoning Capability, Errors and Fast and Slow Thinking
Reasoning Capability, Errors and Fast and Slow Thinking
Topics 6 and 7 and Tutorial 2 explain why good clinicians still reason badly. This chapter covers the three factors behind reasoning capability, knowledge, cognitive skill and data collection, then the errors the course names: priming, confirmation bias, over-reliance on pattern recognition and errors of assumption, with screening questions as their antidote.
It uses Kahneman's fast System 1 and slow System 2 to show why first impressions must be tested, and lists the management errors that follow a weak examination. A counter-example shows a referral priming an entire examination, and a grid matches each error to the element of thinking it damages and its antidote.
What this chapter covers
- 01
Knowledge, cognition and data collection
- 02
Priming by referrals and reports
- 03
Confirmation bias
- 04
Limits of pattern recognition
- 05
Errors of assumption and screening questions
- 06
System 1 and System 2 thinking
- 07
Management reasoning errors
Worked example · free
Catching an error of assumption with a screening question
- +1Error: using only what is volunteered assumes that anything unmentioned is irrelevant.
- +1Priming: the referral label has narrowed the questions to the hamstring.
- +1Screening question: ask whether pain is felt anywhere else, such as the back or buttock, or with coughing or sitting.
- +1Revision: a positive answer adds a spinal referral hypothesis to test before loading the hamstring.
Key terms
- Priming
- Letting earlier information, such as a referral label or scan report, steer expectations too strongly.
- Confirmation bias
- Favouring findings that fit an early impression while neglecting or misreading those that do not.
- Screening questions
- Questions that deliberately search for information the person has not volunteered.
- System 1
- Fast, automatic thinking that runs without effort and cannot be switched off.
- Heuristic
- A mental shortcut, or rule of thumb, that speeds judgement at the cost of accuracy.
- System 2
- Slow, effortful thinking that checks and corrects fast first impressions.
- Errors of assumption
- Mistakes that come from treating unasked or unclarified information as unimportant.
Reasoning Capability, Errors and Fast and Slow Thinking FAQ
What is the difference between priming and confirmation bias?
Priming comes first: prior information, such as a referral or scan report, biases what you expect to find. Confirmation bias follows: you collect and weigh findings that fit the expectation and overlook those that do not. Together they can turn a referral label into a conclusion without any genuine test.
Why does experience not protect against reasoning errors?
Tutorial 2 explains that as experience grows, fast System 1 recognises more presentations and slow System 2 is called on less often. Speed then feels like accuracy. The course's answer is to treat early impressions as hypotheses and to keep checking them, however familiar the case looks.
Which management errors does Topic 7 list?
Routine rather than assessment-based dosage, leaving the patient out of decisions, explaining the rationale poorly, applying too many interventions at once, focusing on impairment rather than function, and using outcome measures too little. The underlying fault is progressing treatment without reassessing outcomes.
What three factors decide clinical reasoning capability?
Topic 6 names knowledge, the cognitive processes of critical thinking, and data-collection skills. Knowledge matters for how it is organised, not just how much there is; thinking skills judge the information; and data collection depends on rapport and empathy, because reasoning cannot be better than the information gathered.
How do heuristics affect a physiotherapy examination?
Heuristics are fast mental shortcuts. Tutorial 2 names availability, judging by how easily examples come to mind, and representativeness, judging by how typical a case looks. Both make a recent or classic case feel likelier than it is, so they should prompt a deliberate check rather than a conclusion.
Why should early impressions be treated as hypotheses?
Because fast, automatic thinking produces them before any deliberate checking, and the patient may not fit the familiar pattern. Tutorial 2 and Topic 7 both recommend calling early impressions working hypotheses and then searching for the findings that would support or refute them before acting.
Exam move
For each tutorial case, write your first impression in one line, then list two alternatives and the finding that would separate them. Practise the brunch exercise approach: separate facts from meanings before you interpret anything. Keep a list of three screening questions you can ask in any examination, and review the management errors before every practical session.
After each tutorial, write down one assumption you made about the case and the fact that later changed it; the list becomes your personal error checklist.
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