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IMAGINE better clinical decision-making

Paying attention to intuition and assessing its plusses and minuses is more important than we might realize

Vol. 9, No. 4 / April 2010

Albert Einstein said, “Imagination is more important than knowledge.” Imagination is not only creative thinking, but also resourcefulness and looking ahead to consider the potential outcomes and consequences of a decision. The ability to imagine—as outlined in the mnemonic IMAGINE—in a supportive environment is critical for good clinical decision-making.1

Issue. What is it and whose issue is it? For example, although an individual may need to be hospitalized, it also is possible that clinicians are not considering resources available to help the patient in a less restrictive setting. It could be that caregivers simply need a respite. An experienced clinician is flexible and has the ability to shift strategies based on the situation.

Move. Step outside the situation and look at it from different angles. Physicians can be prone to seek premature closure when making decisions. Be aware of cognitive errors and continue to self-assess. The busier we are, the greater the risk of maintaining the status quo. Action takes energy. When tempted to avoid a problem, face it.

Account. Consider and document the risks and benefits of your decision, and alternatives. Practice informed consent, and document as if a colleague, the patient, and the patient’s advocate were to review it.

Gut. How do you balance your “gut reaction” and your reasoning? Paying attention to intuition and assessing its plusses and minuses is more important than we might realize.2

Integration becomes crucial as more data become available.3 Often we are asked to help care for an individual we don’t know well or whose circumstances have changed dramatically. Avoid making a poor judgment by evaluating new data and considering a new context.

Network. Learn of agencies and services that could help your patients and foster those relationships. Doing so in noncrisis times can pay dividends during a crisis.

Expand the field. Feel free to ask for assistance. Because of insecurity about our limitations or overestimating our capabilities, clinicians often make decisions without reaching out.


The author wishes to thank Ronald Diamond, MD, Robert Factor, MD, PhD, and Elizabeth Faust, MD for their mentoring.


1. Saint S, Drazen JM, Solomon CG. New England Journal of Medicine: clinical problem solving. New York, NY: McGraw-Hill Professional; 2006.

2. Gladwell M. Blink: the power of thinking without thinking. New York, NY: Little, Brown Book Group; 2005.

3. Del Mar C, Doust J, Glasziou P. Clinical thinking: evidence, communication, and decision-making. Oxford, United Kingdom: Blackwell Publishing Ltd; 2006.

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