The Role of Clinical Judgment in Psychiatry.

Abstract

Clinical judgment is currently perceived as an intuitive art that is going to be replaced by growing technology and artificial intelligence. Even though patients look for good clinical judgment when they seek medical attention and clinicians rely on it, the topic is seldom mentioned and discussed in the literature. In their everyday practice, psychiatrists use observation, description, and classification; test explanatory hypotheses; and formulate clinical decisions based on clinical judgment. The aim of this review was to examine the current role of clinical judgment in psychiatry. We first outline the importance of collecting information that supplements the use of diagnostic criteria (allostatic load, health attitudes and behavior, psychological well-being, personality and iatrogenic factors). Clinimetrics, the science of clinical measurements, provides an intellectual home for the reproduction and standardization of clinical intuitions. The clinimetric translation of clinical reasoning allows the organization of the material that has been collected (staging, building unitary concepts, subtyping, formulating pathophysiological links, and global judgments). Finally, we discuss how clinical judgment is the intermediate step between the general indications that derive from clinical trials and individualized treatment plans, encompassing patients' preferences, treatment articulation and selection, level of care, and interpretation of previous treatment response. Clinical judgment remains the basic method of medicine and psychiatry. Improving its features by clinimetric strategies is likely to yield a highly effective precision psychiatry that is available today to any practicing clinician.