CM: Intro Flashcards
What is the hypothetico-deductive model of clinical reasoning?
clinicians generate hypothesis diagnoses early in pt encounter, then gather more info to test them –> confirmed, made more or less likely, or replaced by another - tested in similar manner
but used the same by experts and novices
What is the mental representation model of clinical reasoning?
organization of knowledge in different formats/representations
include application of basic science concepts, pattern recognition, and bayesian inference
conclusion = expertise comes w practice
What is the dual process theory of clinical reasoning?
includes system 1 (intuitive) and system 2 (analytic)
What are the sources of emotional influences on clinical reasoning?
countertransference
fundamental attribution error
ambient, chronobiological, and other influences
endogenous affective disorders w/i physician - depressive, anxiety, manic
emotional dysregulation in physicians - unconscious defenses, avoidance, anxiety, excessive emotional involvement or detachment
What is the modern physician’s search satisficing?
imperative to search through uncertainty
important to find suitable dx and terminate search at appropriate end point
no agonizing over options
appropriate, quick search more adaptive
What are the neurobiological correlates of the different parts of DPT?
system 1: right inferior prefrontal cortex, occasionally hippocampus
system 2: anterior cingulate cortex, ventral medial prefrontal cortex, medial aspect of temporal lobe
What is the cognitive miser function?
brain always tries to default into system 1
What are the four types of errors?
diagnostic: error or delay, failure to employ indicated tests, use of outmoded tests/therapy, failure to act
treatment (majority)
preventive: failure to provide prophylaxis, inadequate monitoring or follow up
other failure of communication: equipment/system failure
What are the three causes of error?
no fault: dx masked, unusual presentation, pt related
systemic: poor mechanism for care delivery
cognitive: mostly incomplete data gathering
What is the main source of faulty clinical reasoning?
system 1’s heuristic failures
What are the five steps in croskerry’s checklist for debiasing diagnosis?
raise awareness coach the approach to improve rate of systemic and cognitive errors improve ambient conditions reduce cognitive load cognitive de-biasing
What is croskerry’s general checklist for diagnosis?
obtain own complete medical history
perform focused and purposeful physical
generate initial hypotheses and differentiate these with more hx, physical, and diagnostic tests
pause and take diagnostic time-out
embark on plane, but acknowledge uncertainty and ensure pathway for follow-up
What are the five steps to croskerry’s diagnostic time-out?
was I comprehensive?
did I consider inherent flaws of heuristic thinking?
was my judgment affected by any other bias?
do I need to make dx now, or can I wait?
what is the worst case scenario?
What are the high risk situations Croskerry points out?
cognitive overloading fatigue sleep deprivation/sleep debt negative mood/affective state alcohol/drug influence
