[DSA] Illness Scripts and Clinical Reasoning

Question 1

Continuing to treat a ring-like lesion w/ antifungals, and the lesion turns out to be lupus is an example of what kind of bias? How can you correct it?

Answer 1

Anchoring bias

Examine the impact of nonresponse or new information on the original dx

Question 2

Making a diagnosis based on a previous pt with similar sx is an example of what kind of bias? How can you correct it?

Answer 2

Availability bias (referring to what comes to mind most easily)

Know baseline prevalence and statistical likelihoods on the condition diagnosed

Question 3

Concluding that leukocyte esterase present on urine dipstick testing in a patient with back pain aligns with the patient’s self-diagnosis of kidney infection is an example of what kind of bias? How can you correct it?

Answer 3

Confirmation bias

Use an objective source to evaluate whether the diagnosis correlates with technical findings

Question 4

Assuming that sx are malarial in a patient who recently returned from Africa is an example of what kind of bias? How can you correct it?

Answer 4

Framing bias

Elicit different perspectives by broadening the history to search for other causes or associations

Question 5

Failing to note a second fracture after the first has been identified is an example of what kind of bias? How can you correct it?

Answer 5

Premature closure bias

Review the case, seek other opinions, consult objective sources

Question 6

What type of clinical reasoning is used more often by experienced clinicians? Novices?

Answer 6

Expert - Pattern recognition - may be affected by biases

Novice - analytical reasoning - slower process

Question 7

What is an illness script? How are they built by physicians?

Answer 7

Mental cue card to represent individual diseases

Built by:

Novice - reliance on biomedical knowledge

Intermediate - organized knowledge using signs and sx

Expert - clinical features create narrative to rule in/out DDX

Question 8

What are the 4 main components included in illness scripts?

Answer 8

Epidemiology

Temporal course

Pathophysiology

Clinical presentation

Question 9

Clinical presentations in illness scripts must have what?

Answer 9

Must have features - without it, dx cannot be included in differential

Rejecting features - if present, dx cannot be made