How Vets Make Decisions: It’s not just about logic (#385)

When the day gets busy, or fatigue sets in, the first casualty in a veterinarian’s schedule is often thinking time.

To stay afloat, we unconsciously pilfer from our cognitive reserves.

Reasoning gives way to reflex.

Decisions become reactive rather than reflective.

What began as thoughtful clinical practice can slide into autopilot. Habits, heuristics and gut feelings take over. While these shortcuts can be efficient, they’re also dangerous if left unchecked. We lose the pause. We lose the why.

Veterinary reasoning, like any precision tool, needs time to work. But time is the one resource under relentless pressure in a clinic.

Protecting our thinking space isn’t a luxury.

It’s a professional obligation.

Because those moments when we don’t have time to think is precisely when reasoning matters most.

Clinical Reasoning in Small Animal Practice (2nd ed., 2022) presents a clear, problem-based framework for diagnosing and managing clinical cases in small animals, exotics, and equines. The editors (Jill Maddison, Holger Volk, and David Church) offer structured decision trees, flowcharts, and illustrative case studies for common clinical problems like vomiting, weight loss, bleeding, pruritus, and more, across species.

New in this edition is a chapter on professional reasoning and decision-making, helping vets choose diagnostic tests logically, interpret findings, and communicate effectively with animal owners.

In another book, The Enigma of Reason (2017), Mercier and Sperber propose that our reasoning skills evolved not so much to find objective truth in isolation, but to defend decisions, persuade others, and navigate social dynamics. Reasoning works best when scrutinized by peers, and rationalizations often come after decisions, not before.

Where These Perspectives Converge in Veterinary Medicine

• Structured Thinking Meets Social Scrutiny: Maddison et al. provide decision support tools to guide logical thinking under pressure. Yet Mercier & Sperber remind us that clinical reasoning rarely happens alone: vets justify diagnostic pathways to colleagues, clients, and teaching rounds. Reason becomes a shared tool. Cases are reviewed in journal clubs, hospital rounds or peer consultations where logical structures are stress-tested by others’ questions.

• Dual-Process Reasoning & Rationalization: Veterinary evidence reviews describe Type 1 reasoning (heuristic, intuitive pattern recognition) versus Type 2 reasoning (analytical, slow reasoning) and note that combining both improves accuracy. But expert reasoning errors still occur if not challenged. Maddison et al.’s flowcharts encourage slow, structured reflection. Mercier & Sperber would suggest clinicians may nonetheless use reasoning to defend their initial impressions unless social feedback intervenes.

• Mentorship as Social Logic: Reasoning frameworks in Maddison’s book serve students, but the real transfer of skill occurs through mentorship and modeled case discussions. As Mercier & Sperber argue, reasoning shapes and is shaped by social context. Veterinary students internalize mentors’ argumentation habits, their questioning style, and how they justify or revise diagnostic decisions.

• Explaining Choices to Clients: Reasoning Is performance. Professional reasoning involves communicating diagnosis, prognosis, and rationale to pet owners. Mercier & Sperber’s framing helps us see that reasoning in veterinary practice also functions as persuasion and justification. Reasoning builds trust and guides compliance. The structures offered by Maddison et al., including a clear rationale for test selection or treatment recommendation, support that social performance of logic.

Why This Matters: A Unified View of Veterinary Reasoning

By integrating both views, we appreciate that good clinical reasoning is not just correct logic. It’s logic that withstands critique and is articulated effectively. The flowcharts help map decisions; the social theory explains why we often default to justification rather than revision and why we need critical peers.

Rick’s Commentary

Maddison, Volk, and Church deliver a rigorous and accessible toolkit for veterinary reasoning.

But Mercier & Sperber remind us of the deeper psychology at play: reasoning is shaped by social exchange, defense, and persuasion.

In veterinary settings, reasoning is strongest when structured meets social.

When case logic is publicly debated, teaching is collaborative, and client communication is transparent.

Together, these perspectives show that the best diagnostic tool might not be a test. It’s conversation.

How does collaborative case review shape your reasoning?

• In my own experience, and in countless veterinary practices around the world, collaborative case review serves as a crucible for better thinking. When we present a challenging case in rounds or consult a colleague, we are not just seeking second opinions; we are exposing our logic to constructive pressure. This often forces us to clarify our assumptions, revisit overlooked data or explore differential diagnoses we had mentally discarded. Some of my best diagnostic moments have emerged not from solo reflection but from spontaneous conversations in the break room, from teaching clinics, or from being gently questioned by a student who hadn’t yet learned what not to ask.

  
  

• These interactions remind me that:

Reasoning improves when it's shared and challenged.

Do you use structured pathways and flows or rely more on pattern recognition?

• The truth is: I use both. In urgent scenarios pattern recognition kicks in fast. Years of experience whisper, This looks like X. But when cases don't fit neatly, or when a patient fails to respond as expected, I turn to structured frameworks like those in Maddison et al.'s book. Flowcharts and decision trees help keep emotions at bay and prevent premature closure.

  
  

The key is knowing when to switch modes.

Pattern recognition is efficient but can be treacherous if unchecked.

Structure is safer but slower.

The best veterinarians toggle between the two with humility and awareness.

What helps you explain complex medical decisions to pet owners?

This is where Mercier and Sperber's theory truly resonates: reason is for justification. And in clinical practice, that justification must be credible, compassionate, and clear.

I’ve found that metaphors often help. Comparing a ruptured intervertebral disc to a slipped jelly doughnut, or explaining immune-mediated disease as the body mistaking friend for foe.

But above all, I’ve learned to tell the story of the case.

Owners want to understand what we’re doing and why, not just hear a list of tests.

They want to be taken along on the diagnostic journey.

Not left behind in a haze of jargon.

When I walk them through my thought process, both structured and intuitive, it builds trust.

In the end, trust may be the most powerful medicine we have.

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