The predictive brain model in diagnostic reasoning

Abstract

Introduction: Clinical diagnosis is a pivotal and highly valued skill in medical practice. Most current interventions for teaching and improving diagnostic reasoning are based on the dual process model of cognition. Recent studies which have applied the popular dual process model to improve diagnostic performance by “Cognitive De-biasing” in clinicians have yielded disappointing results. Thus, it may be appropriate to also consider alternative models of cognitive processing in the teaching and practice of clinical reasoning. Methods: This is critical-narrative review of the predictive brain model. Results: The theory of predictive brains is a general, unified and integrated model of cognitive processing based on recent advances in the neurosciences. The predictive brain is characterised as an adaptive, generative, energy-frugal, context-sensitive action-orientated, probabilistic, predictive engine. It responds only to predictive errors and learns by iterative predictive error management, processing and hierarchical neural coding. Conclusion: The default cognitive mode of predictive processing may account for the failure of de-biasing since it is not thermodynamically frugal and thus, may not be sustainable in routine practice. Exploiting predictive brains by employing language to optimise metacognition may be a way forward.