Introduction - Week 1 Flashcards
History of differential Diagnosis
Movement away from _____-_____ medical theory or bodily humors theory to a more modern _____ approach.
Early theory that disease was an outcome of _____ in one of the four bodily fluids: _____, _____ bile, _____ bile, and _____.
Movement away from Hippocratic-Galenic medical theory or bodily humors theory to a more modern scientific approach.
Early theory that disease was an outcome of imbalances in one of the four bodily fluids: blood, yellow bile, black bile, and phlegm.
History of differential diagnosis
New and emerging ______ tools to assist medical _____.
William _____ a Canadian physician (18__-19__) founded North American Clinical Medicine.
New and emerging diagnostic tools to assist medical examination.
William Osler a Canadian physician (1849-1919) founded North American Clinical Medicine.
Clinical reasoning
1) _____ knowledge
2) _____ knowledge
3) _____ knowledge
4) _____ expertise
1) Conceptual knowledge
2) Procedural knowledge
3) Scientific knowledge
4) Individual expertise
Case based clinical reasoning method
1) _____ representation
2) Building _____ scripts
3) Systematic, analytic reasoning - _____
1) Problem representation
2) Building illness scripts
3) Systematic, analytic reasoning - ISBAR
ISBAR
1) _____ or _____
2) S_____
3) B_____
4) A______
5) R______
1) Introduction or Identify
2) Situation
3) Background
4) Assessment
5) Reccomendation
Introduction or Identify
Who you are, your _____, where you are and why you are _____.
Who you are and what is your role?
Patient ______
Who you are, your role, where you are and why you are communicating.
Who you are and what is your role?
Patient identifiers
Situation
What is _____ at the moment?
What is the key _____ that the patient presented with, and what made them come to you.
What is going on with the _____?
What is happening at the moment?
What is the key symptom that the patient presented with, and what made them come to you.
What is going on with the patient?
Background
What are the _____ that led up to this situation?
What is the clinical _____/_____?
What are the issues that led up to this situation?
What is the clinical background/context?
Assessment
What do you believe is the _____?
What do you believe is the problem?
Recommendation
What should be done to _____ the situation?
What would you _____?
Risks - patient/_____ health and safety?
Assign and accept _____/_____.
What should be done to correct the situation?
What would you recommend?
Risks - patient/occupational health and safety?
Assign and accept responsibility/accountability.
Barriers to communication in healthcare
1) S_____/_____
2) _____ constraints
3) I_____
4) _____ state
5) _____ effects
6) R_____/_____
7) G_____
1) Speech/language
2) Time constraints
3) Illness
4) Mental state
5) Medication effects
6) Race/culture
7) Gender
Attributes of clinical reasoning
Holistic & contextual perspectives - _____ of whole person, their entire _____, relationships, background and _____.
Creativity - ability to generate, discover or _____ ideas,; ability to imagine _____.
Holistic & contextual perspectives - consideration of whole person, their entire situation, relationships, background and environment.
Creativity - ability to generate, discover or restructure ideas; ability to imagine alternatives.
Attributes of clinical reasoning
Inquisitiveness - thoughtful, _____ and curious approach; explore _____ and alternatives.
Perseverance - _____ to pursuit knowledge despite and _____ that are encountered.
Inquisitiveness - thoughtful, questioning and curious approach; explore possibilities and alternatives.
Perseverance - dedication to pursuit knowledge despite any obstacles that are encountered.
Attributes of clinical reasoning
Intuition - insightful patterns of knowing from previous _____ and _____ recognition.
Flexibility - capacity to adapt, modify or change thoughts, ideas and _____.
Intuition - insightful patterns of knowing from previous experience and pattern recognition.
Flexibility - capacity to adapt, modify or change thoughts, ideas and behaviours.
Attributes of clinical reasoning
Academic integrity - seeking truth through _____ process.
Reflexivity - contemplation of assumptions, thinking and behaviours for purpose of deeper ______ and self-_____.
Academic integrity - seeking truth through honest process.
Reflexivity - contemplation of assumptions, thinking and behaviours for purpose of deeper understanding and self-evaluation.
Attributes of clinical reasoning
Confidence - firm belief in one’s _____ ability.
Open-mindedness - receptiveness to different views and sensitivity to one’s bias, prejudice, preconception and assumptions.
Confidence - firm belief in one’s reasoning ability.
Open-mindedness - receptiveness to different views and sensitivity to one’s bias, prejudice, preconception and assumptions.
Cognitive errors in diagnosis
Anchoring - tendency to lock onto _____ features in patient’s presentation too early in the clinical reasoning process, and _____ to adjust to this initial impression in the light of later _____.
Ascertainment bias - clinician’s thinking is shaped by prior assumptions and preconceptions, for example, _____, _____, and _____
Anchoring - tendency to lock onto salient features in patient’s presentation too early in the clinical reasoning process, and failing to adjust this initial impression in the light of later information.
Ascertainment bias - clinician’s thinking is shaped by prior assumptions and preconceptions, for example, ageism, stigmatism, and stereotyping.
Cognitive errors in diagnosis
Confirmation bias - tendency to look for confirming _____ to support a clinical diagnosis rather than look for _____ evidence to refute it, despite the latter often being more _____ and definitive.
Diagnostic momentum - once labels are attached to patients, they tend to _____. What started as a possibility gathers increasing _____ until it becomes definite and other _____ are excluded.
Confirmation bias - tendency to look for confirming evidence to support a clinical diagnosis rather than look for disconfirming evidence to refute it, despite the latter often being more persuasive and definitive.
Diagnostic momentum - once labels are attached to patients, they tend to stick. What started as a possibility gathers increasing momentum until it becomes definite and other possibilities are excluded.
Cognitive errors in diagnosis
Fundamental attribution error - tendency to be judgmental and blame patients for their illness rather than examine the _____ that may have been responsible. Patients with a mental illness and from _____ or marginalised groups are at particular risk of this error.
Overconfidence bias - tendency to believe we know more than we do. It reflects a tendency to act on incomplete _____, _____ or hunches. Too much faith is placed on opinion instead of carefully collected cues. This error may be augmented by _____.
Fundamental attribution error - tendency to be judgmental and blame patients for their illness rather than examine the circumstances that may have been responsible. Patients with a mental illness and from minority or marginalised groups are at particular risk of this error.
Overconfidence bias - tendency to believe we know more than we do. It reflects a tendency to act on incomplete information, intuition or hunches. Too much faith is placed on opinion instead of carefully collected cues. this error may be augmented by anchoring.
Cognitive errors in diagnosis
Premature closure - tendency to accept a _____ without sufficient evidence and before it has been fully verified. This error accounts for a high proportion of _____ or _____ diagnoses.
Psych-out error - people with a _____ illness are particularly vulnerable to clinical reasoning errors, and co-morbid conditions may be overlooked or minimalised. A variant of this error occurs when medical condition are misdiagnosed as _____ conditions.
Unpacking principle - failure to collect and unpack all of the relevant _____ and consider differential diagnoses may result in significant _____ being missed.
Premature closure - tendency to accept a diagnosis without sufficient evidence and before it has been fully verified. This error accounts for a high proportion of inaccurate or incomplete diagnoses.
Psych-out error - people with a mental illness are particularly vulnerable to clinical reasoning errors, and co-morbid conditions may be overlooked or minimalised. A variant of this error occurs when medical condition are misdiagnosed as psychiatric conditions.
Unpacking principle - failure to collect and unpack all of the relevant cues and consider differential diagnoses may result in significant possibilities being missed.
