Clinical Practice and Heuristic Reasoning

An understanding of heuristic reasoning has long been seen as important by researchers in human decision making (Newall & Simon, 1972). Recently, attention to this phenomenon has also arisen in social work (Heineman Pieper, 1989; Tyson, 1992). The decision strategies incorporated in heuristic reasoning have been viewed as both essential (Braunstein, 1976) and dangerously misleading (Kahneman, Slovic, & Iversky, 1982). However, despite possible drawbacks, this form of reasoning continues to generate interest because decision makers are often forced to rely on such informal methods to render decisions in pressured work environments (Cohen & March, 1986). Until recently, discussions of heuristic reasoning in social work have been confined to issues of research methodology. Lately, this theme has begun to emerge in discussions of clinical practice (Goldstein, 1990; Imre, 1991; Nurius & Gibson, 1990). What is Heuristic Reasoning? Heuristics are basically rules for decision -- or what Wildavsky (1974) termed "aids to calculation. " Both formal and informal clinical decision rules have been identified (Arocha, Vimla, & Vimla, 1993; Holtgrave, Lawler, & Schweibert, 1993); informal heuristics are discussed in this article. Such heuristics can be defined as rough rules of thumb used to solve problems (Haugeland, 1989). These rules have been identified as integral components in clinical judgment (Schon, 1983). Such heuristics do not always give the correct answer but are generally adequate or "good enough" for everyday behavior. The following are some common examples of informal heuristic rules: * Red sky in the morning, sailors take warning. * First come, first served. * The shortest waiting line is the fastest. * If it ain't broke, don't fix it. To better understand the use of such informal rules, the following description by Wiest (1975) is helpful: We all use heuristics in our daily living, drawing them from our knowledge and experience. We devise simple rules of thumb that free us from the task of solving the same or similar problems over and over again. For example, consider the rule, "when the day is cloudy, take an umbrella to work. " The problem at hand is how to defend oneself against the potential discomforts of the weather. For many problems of this kind, we lack the time or inclination to employ more thorough problem-solving procedures. A simple . rule serves us best. (p. 382) Informal Heuristics as Decision Strategies The idea that heuristic reasoning in practice situations is made up of various decision strategies has generated various attempts to identify the strategies most often used by decision makers. Werner, Rose, and Yesavage (1983), for example, studied the informal decision strategies used by hospitals in making predictions about the imminent dangerousness of psychiatric inpatients. Other research has included studies of screening decisions in psychiatric emergency rooms (Segal, Watson, & Nelson, 1985), decision making in psychiatric emergencies (Murdach, 1987), social workers' decision making about violent clients (Werner, Rose, Murdach, & Yesavage, 1989), strategies for involving volunteer clients in treatment (Rooney, 1988), and decision making in the "welfare bureaucracy" (Schmidt, 1990). Of particular interest are the investigations of clinical decision making conducted by Rennels, Shortliffe, and Miller (1987). Drawing on research done on multiattribute decision making and other work in artificial intelligence, Rennels et al. proposed four decision strategies for management of patient care: 1. lexicographic ordering -- Solutions are ranked according to acceptability and the most preferred is selected. 2. …