It’s often assumed that decision making in medicine should be done slowly. As a young trainee I was lead to believe that the doctor with slow medical thinking is more thorough. Conversely we assume the faster moving professional is cutting corners.

But the time in any clinical day is fixed and our bandwidth is a zero-sum game. While respecting the risk for cognitive bias, the trick is knowing what can be done quickly and what needs slow, thoughtful consideration. Nobel Laureate Daniel Kahneman’s work has centered on the dichotomy between these two modes of thinking. He has characterized them as “System 1″ – fast, instinctive and emotional; “System 2” – slower and more logical.

This is subjective and dependent upon your stage of expertise, of course. When you’re a new physician, there are more problems that require slow medical thinking. Being a medical student is torture because you live under the belief that everybody with an upper respiratory infection needs 12 cranial nerves assessed.

The master clinician is defined by the earned capacity to know how and when to apply fast and slow medical thinking.

And she respects each one equally.

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Image via Mathew Schwartz