A decision theory overview and case-based discussion

Practitioners use decision theory in everyday practice. However, little consideration is given to the processes used to arrive at a diagnosis. This article will briefly explore the theory behind decision-making in paramedic practice. A hypothetical but realistic case, set in a hospital, will be used to show how the theory is applied in practice.

The example given in this article uses a hospital inpatient to discuss the difficulties in diagnosing those with undifferentiated pathology, but the themes relate directly to prehospital care. The rationale for choosing an inpatient is for a greater depth of understanding and to showcase the roles in which a paramedic may find themselves working with a need to understand decision theory in greater detail.

An elderly person is an inpatient on an acute medical ward following an unplanned admission with systemic infection against a background of medication non-compliance. The patient had been treated on the ward for more than a week before there was an acute change in their presentation, and ward staff noted a stepwise decrement in the patient's consciousness levels. The patient's Glasgow Coma Score had steadily declined over the course of the day, with a single hypoglycaemic episode earlier in the day having been successfully treated. A review of the notes elicits a new diagnosis of acute kidney injury (AKI) on day 5 of admission.