Reconceptualizing Clinical Priority as Relational Influence: Derivation of Drawing Reasoning From a Sequential Programme of Research.

Authors

Alessandra Milani, Eliana Misurelli, Ketti Mazzocco

Published in

Journal of evaluation in clinical practice. Volume 32. Issue 6. Pages e70602.

Abstract

Determining which patient problem requires attention first is a continuous cognitive task with direct consequences for patient safety. Despite its centrality, clinical prioritization remains conceptually underdeveloped. Organizational models frame it as protocol-driven; experiential models assume it improves with clinical exposure. Neither addresses the specific cognitive challenge that prioritization poses when patients present with multiple interacting conditions.
To reconceptualize clinical prioritization as a distinct cognitive task requiring relational integration under uncertainty, and to derive drawing reasoning, a structured visual method designed to support this process, from a three-study sequential programme of research.
Conceptual development through sequential derivation. Three linked studies provided inputs: a theoretical integration combining complexity science, psychoneuroendocrinoimmunology, dual-process theory, and the Theory of Event Coding; a qualitative study documenting how clinicians define priority (N = 104); and an experimental study identifying cognitive biases and accuracy collapse when clinical data conflicted with expectations (N = 130). Cross-study findings were synthesized to produce definitions, an operationalized method, and testable propositions.
The programme produced two conceptual outputs and one methodological output. Systemic priority is defined as the variable exerting the strongest relational influence within the patient's clinical configuration. Iterative reasoning is specified as a safety-critical cognitive operation whose interruption is empirically linked to systematic errors in prioritization. Drawing reasoning translates these outputs into a three-phase method, variable elicitation, relational mapping, and priority identification with conflict check, that directly targets the cognitive vulnerabilities documented experimentally.
Clinical prioritization under complexity is a distinct cognitive task that is not reducible to urgency ranking or accumulated experience. Drawing reasoning provides a teachable and testable method warranting empirical evaluation, particularly in chronic, multimorbid, and educational contexts.

PMID:
42732561
Bibliographic data and abstract were imported from PubMed on 14 Sep 2026.

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