Posted on in General

It is unusual for anyone to think about the quality of medical decision making. It is assumed that the process works perfectly. Unfortunately, it does not always work to the patient’s benefit.

We are interested in how medical thinking and deciding can be improved.

Daniel Goleman, the author of a FOCUS, The Hidden Driver of Excellence, has studied how decisions can be improved.

In his book, he describes “open awareness”. It is a form of attentiveness characterized by “utter receptivity to whatever floats into the mind”. According to Goleman, it is the source of most creativity.  Creativity is important when advising clients with complex health problems.

Open awareness goes beyond “orienting” in which we deliberately gather information ( hello google) and “selective attention” in which we concentrate on solving a particular problem.

Open awareness frees the brain to make connections and associations that lead to new ideas and new solutions for patients.

Goleman writes how “top down wiring” from the neo-cortex ( our modern brain compared to the old or reptilian brain) adds talents like self awareness and reflection, deliberation and planning to our mind’s tool kit.

There are many distractions with medical decision making. These distractions may reduce the attention required to arrive at a thoughtful opinion or conclusion about a patient.

Because of distraction, our ability to experience “open awareness” is at risk. Some clinicians might not even attempt to reach that state because their thinking is confined to the world of medical studies. The medical evidence rules.  No room for being too creative.

Goleman states that our search engine culture celebrates information gathering and problem solving. This is associated with orienting and selective focus but not open awareness. So much for evolution.

Other authors such as Clive Thompson in “Smarter Than You Think” argue that using technology is making us smarter. According to Thompson, it is the symbiosis of the computer and the human brain working together that elevates our decision making process.

This is very important in medical decision making.  The technology provides the data, the clinician’s mind should supply the creativity and the solution to the complex problem.

Goleman posits that social connection through social media limits solitude, which is sometimes necessary for open awareness and deep thinking.  So distraction and connection are, according to Goleman, limiting our ability to problem solve.

Other authorities such as Albert Bandura of Stanford University observe that the best decision makers are social learners. They take their problems to others and ask their opinions. Then social learners take the differing opinions, parse them and formulate their own opinions which are, on balance, better decisions.

Conclusions- take time to be alone with your thoughts, allow for open awareness, use technology to gather information, do not shy away from being creative even if you are proven at first blush to be wrong, do not be afraid to ask others what they think and the end result be will be deeper and better decisions.

This decision strategy will prove to be important when a patient has one or more very complex problems that need noodling.


Smarter Than You Think, Clive Thompson, Penguin Press, 2013.

Focus, The Hidden Driver of Excellence, Daniel Goleman, Harper, 2013.

Self-efficacy: the exercise of control. Bandura, Albert. (1997). New York: W.H. Freeman.

Social Foundations of Thought and Action: A Social Cognitive Theory.  Bandura, Albert. (1986). Englewood Cliffs, N.J.: Prentice-Hall.

p.s. Albert Bandura is a very famous psychologist who comes from a town of 400 persons- Mundare, Alberta, Canada.