Illness Scripts and Flaws in Clin Med DSA

Question 1

What is an illness script?

Answer 1

mental cue cards used to represent individual diseases

Question 2

Why are illness scripts important?

Answer 2

enable pattern recognition

inform hx taking based on patterns identified

enhance the integration of new knowledge w/ prior knowledge

improve diagnostic efficiency and accuracy

Question 3

How does an expert’s illness script differ from a novice’s?

Answer 3

novice = detailed biomedical knowledge

expert = clinical features; weigh biomedical stuff w/ pt presentation

Question 4

What is the basic organization of an illness script?

Answer 4

epidemiology: who gets it?

temporal course: how does the dz present w/ respect to time?

pathophysiology: what are the biomedical causes of this dz?

clinical presentation

Question 5

What should be included in your minset of an expected clinical presentation?

Answer 5

key and differentiating features

must include rejecting features

Question 6

What is an anchoring bias and how do you prevent it?

Answer 6

sticking with a diagnosis even if its not really working

corrective strategy: examine the impact of nonresponse or new info on the original diagnosis

Question 7

What is availability bias and how do you correct it?

Answer 7

referring to what comes to mind most easily, often based on a previous pt with similar sx

corrective strategy: know baseline prevalence and stat likelihoods of the condition diagnosed

Question 8

What is confirmation bias and how do you correct it?

Answer 8

assigning preference to findings that confirm a diagnosis or strategy

corrective strategy: use an objective source (diagnosis checklist, etc) to evaluate whether the diagnosis correlates w/ technical findings

Question 9

What is framing bias and how do you correct it?

Answer 9

assembling elements that support a diagnosis (assuming sx are malarial in someone who was just in africa)

corrective strategy: elicit different perspectives by broadening the hx to search for other causes or associations

Question 10

What is premature closure bias?

Answer 10

failing to seek additional info after reaching a diagnostic conclusion

corrective strategy: review the case, seek other opinions, and consult objective resources

Question 11

What is the bias of groupthink?

Answer 11

agreement is reached based on an authoritative source (lab and imaging test results) w/out sufficient examination