module 5 dx reasoning and clinical judgement Flashcards
clinical evaluation
organized thought process - collect info and sort into body systems Evaluate and integrate information Assign priorities Generate hypothesis/differential dix - pos./neg. findings to support hypothesis Form clinical opinion Make assessment/dx
Assessment/Dx
Presenting S/S New findings Unusual findings - clinical exam - dx tests Personal or social difficulties
Valid hypotheses need
Coherence
Adequacy
Rival hypothesis
Parsimony
Coherence
consistent with chief concern and data
adequacy
expected normal and abnormal findings with hypothesis
pertinent pos/neg
Rival Hypothesis
Anything else that could also explain the info and findings just as well?
Parsimony
Occam’s razor or lex parsimoniae
-Father William of Occam: 14th cent english logician/theologian “entities must not be multiplied beyond necessity.”
Start with more common Dx first
Dx reasoning
common problems occur commonly
a rarity that has a necessary tx
consider multi-dimension aspects
Bayes formula
Bayes Formula
likelihood of dx being related to your findings depends on the probability of those findings being assoc. with that dx
- prevalence of that dx and the combo of findings in the community
possible barriers Mechanistic thinking
a sense that knowledge must be certain
possible barriers probabilism
certainty in knowledge is impossible
validity of exam
value Hx and clinical exam
limit the indiscriminate use of technology
EBP
plan/management
integrate pt preference
professional preferences
further assessment
individualize care
Goals to become expert clinician (7)
communication skills identify important clues perform advanced examination organize the info see patterns generate accurate dx develop appropriate management plans
