Clinical Decision Making

Question 1

Elements of Reasoning- 8 things to consider

Answer 1

1. Purpose, goal, objective. The patient needs your help.
2. Problem to be solve. CC or question to be answered.
3. Point of view frame of reference. The perspective of the patient or caregiver.
4. Assumptions. What is taken for granted, known true data divulged by the patient or already on record.
5. Information. Data, facts, observations, experiences, from the patient’s own words, your observations or from diagnostics.
6. Concepts. (Medical theories, definitions, principles, laws).
7. Interpretation. (Conclusions and solutions you have decided on).
8. Implications, Consequences. What happens if you going a certain direction? Can you cause harm?

Question 2

7 Standards of Critical Thinking

Answer 2

Clarity
Accuracy
Precision
Relevance
Depth
Breadth
Logic

Question 3

7 basic attributes

Answer 3

Location
Quality
Quantity/Severity
Timing (onset,duration,frequency)
Factors that aggravate/that relieve
Associated symptoms per organ system

Question 4

Which examination should be performs to discover further clues?

Answer 4

Always examine one system above and one system below.
Move from head dismally with complete physical.
Move proximal to distal with focused exam.

Question 5

Which diagnostic studies should be performed to confirm or negate your suspicions?

Answer 5

CBC, chemistries, coags (things that caught blood), cardiac enzymes, urinalysis, wet prep cultures, x-Ray, CT scan, MRI, US, Doppler studies (ultrasound)

Question 6

Missed Diagnoses

Answer 6

Representative Error (wording)
Attribution Error (personality)
Affective Error (emotional)
Availability Error
Anchoring Error
Satisfaction of search
Commission Bias
Vertical line failure
Ockham's razor (simplest answer, often correct, very few assumptions).