Although the assumption is generally made that information used in clinical reasoning
is objective, and that thinking is logical, these conditions are not always met.9 Two phenomena
that may undermine objectivity and rational thinking are cognitive and emotional influences.
However, the latter has received much less attention. In a review of Groopman’s book How
Physicians Think, 10 Horton draws attention to the historical failure in medicine to appreciate the
importance of emotion in decision making: ”Most physicians fail to recognize, let alone
analyze, their own emotional states in clinical encounters. This repression of feeling misses an
important variable in the assessment of a patient's experiences and outcome. The emotional
temperature of the doctor plays a substantial part in diagnostic failure and success‟.
11
In another recent book, Quirk states: “The literature is quite clear that affect, specifically mood,
can also “intuitively” influence decision making and performance… From research, we can infer
that medical students and practitioners alike who are happy, sad, depressed, anxious, or even
angry may unwarily alter their clinical decision -making processes.”12