Emotion may enter into the thinking process in a variety of ways. The complexity of this
interaction has been reviewed.15,16 The amygdala mediates innate and acquired emotional
responses, conscious and unconscious feelings, and interfaces with the decision making
processes of the frontal cortex.17 It has been demonstrated that the cognitive activity that underlies clinical decision making may be altered by even moderate changes in emotional state,
positively or negatively influencing the choice of strategies in decision making and problem
solving.18 This critical three-way interplay is illustrated in the Figure. Thus, emotional state
may exert a significant influence on decision making. For safe patient care, providers need
competence in procedural, cognitive and emotional domains.19 Procedural competence
involves the acquisition and maintenance of specific skills that require co-ordination primarily in
visual, motor and touch modalities; 20 it is manifest prominently in surgical fields. Cognitive
competence is described by the ability to apply appropriate thinking to an adequate knowledge
base, and is characterized in formulating a diagnosis and appropriate management plan.21
Emotional competence would therefore describe the ability of the clinician to recognize emotions
and, if necessary, limit potential influences of their own emotional state on diagnostic and
treatment decisions.