Clinical Reasoning

Question 1

where can clinical reasoning go wrong?

Answer 1

• Fail to think laterally – generate enough diagnoses
• Fail to appreciate the patient’s agenda
• Close down differential too soon
• Generate inappropriate working diagnosis
• Cognitive bias

Question 2

strategies for developing skills in clinical reasoning

Answer 2

• Widening differential – surgical sieve
• Reading around presentation syndromes
• Deliberate practice
• Compare and contrast different diseases
• Processing to medical language to facilitate problem representation
• Considering red flags/must not miss diagnoses

Question 3

hypothetico-deductive model of making a diagnosis

Answer 3

• Analytical reasoning
• Using information to generate ideas about possible diagnoses
o Epidemiology – age, gender etc
o Presenting symptoms
o Clarifying enquiry start with open questions
• Consider what aspects of the case do not fit the possible diagnosis
o Key and differentiating features
• Using focused questions to confirm or refute diagnosis
Turning a symptom into a diagnosis:
• Consider all the possible diagnoses
• Narrow it down to a likely ballpark
• Then using all available information, reduce DD to the one(s) that best fit the patient. Why do
you think these are the most likely diagnoses?

Question 4

dual process theory model of making a diagnosis

Answer 4

• Intuition easy “pattern recognition”
o Pathognomic presentation and using heuristics
o System one thinking
o Thinking fast
• Deliberate analytical approach
o Extensive information gathering, and hypothesis generation
o System two thinking
o Thinking slow

Question 5

cognitive load theory model of making a diagnosis

Answer 5

• Human short-term working memory can only process so many pieces of information
simultaneously (7±2 or 4±2 depending on field)
• Memory chunks into larger units for easier storage and access
• Chunking uses long-term working memory which is believed to have endless capacity

Question 6

illness scripts model of making a diagnosis

Answer 6

• Experts store a limitless number of packets of information in their brain known as illness
scripts, a different cognitive structure than novices use
• They are shaped by reading and refined by clinical experience
• Their structure facilitates compare and contrast thinking and access of information in a clinical
environment
• Reading in presentation syndromes may facilitate the development of illness scripts

Question 7

the Murtagh Diagnostic model: anchoring

Answer 7

tendence to fail to adjust initial impression in light of later information

Question 8

the Murtagh Diagnostic model: availability

Answer 8

judge diagnosis as being more likely if readily comes to mind. common things are common

Question 9

the Murtagh Diagnostic model: confirmation bias

Answer 9

tendence to give preferential attention to confirming evidence for a diagnosis rather than disconfirming evidence

Question 10

the Murtagh Diagnostic model: diagnosis momemtum

Answer 10

once diagnostic label becomes attached to patient it tended to stick

Question 11

the Murtagh Diagnostic model: framing effect

Answer 11

how diagnosticians see things be strongly influenced by how they have been framed by other individuals

Question 12

the Murtagh Diagnostic model: overconfidence bias

Answer 12

tendency to believe we know more than we do acting in incomplete information, intuitions or hunches

Question 13

the Murtagh Diagnostic model: premature closure

Answer 13

accepting a diagnosis before it has been fully verified

Question 14

the Murtagh Diagnostic model: search satisficing

Answer 14

call off search once something is found missing something else

Question 15

the Murtagh Diagnostic model: triage cueing

Answer 15

patient triaged in a particular direction cues their subsequent management