Educational Strategies to Promote Clinical Diagnostic Reasoning (NEJM 2006;355(21):2217)<\/p>\n
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\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Sit at patient\u0092s bedside to collect a thorough history.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Perform an uninterrupted physical examination.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Generate life-threatening and most likely diagnostic hypotheses.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Use information databases and expert systems to broaden diagnostic hypotheses.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Collect data to confirm or exclude life threats first, then most likely diagnoses.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Avoid diagnostic testing whenever possible by using readily available decision-making algorithms (e.g., Ottawa ankle rules).<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Order only those tests that will affect disposition or that will confirm or exclude diagnostic hypotheses.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Include decision rules on diagnostic testing order forms.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Use guidelines and protocols for specific therapeutic decisions to conserve mental energies while on duty.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Allow 2 to 3 minutes of uninterrupted time to mentally process each patient.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mentally process one patient at a time to disposition.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Avoid decision making when overly stressed or angry. Take 1 to 2 minutes out, regroup, then make the decision.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Carry a maximum of 4 to 5 \u0093undecided\u0094 category patients. Stop\u0097make some dispositions.<\/p>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Use evidence-based medicine techniques to substantiate decisions with evidence, understand the limitations of the evidence, and to answer specific questions, such as usefulness of diagnostic testing, management plans, and disease prognosis.<\/p>\n
(Rosen’s)<\/p>\n
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Life is short, the art long, opportunities fleeting, experience treacherous, judgment is difficult – Hippocrates<\/p>\n
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Cognitive Forcing Strategies in Clinical Decision Making (Annals EM 41:1, Jan 2003)<\/p>\n
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Don’t Let an ugly fact ruin a beautiful theory<\/p>\n
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It’s far easier to keep up than catch up<\/p>\n
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Empathy as method acting article (JAMA 2005;293(9):1100)<\/p>\n
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Warnings and Commiserations produce a nocebo effect (Pain 2005;114:303)<\/p>\n
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The diagnostic approach: the restricted rule-out<\/strong><\/p>\n Many doctors come to use some variant of the restricted rule-out method, which recognises that we cannot rule out all of the alternative diagnoses for each presenting complaint, but that there is a short list of serious ones that we absolutely must rule out. The method involves constructing a limited list of serious diagnoses to be ruled out, in addition to constructing a conventional list of the most likely differential diagnoses.3 This process utilises features from the history, examination, and investigations. (BMJ April 2009)<\/p>\n <\/p>\n <\/p>\n outcome biasEM docs changed their perception of the case depending on how the pt didAnn Emerg Med 2011;57:323<\/p>\n <\/p>\n Acad Med. 2012 Jun;87(6):785-91. doi: 10.1097\/ACM.0b013e318253acbd.<\/p>\n The relationship between response time and diagnostic accuracy.<\/p>\n System 2 is not necessarily better in EM<\/p>\n","protected":false},"excerpt":{"rendered":" Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[14],"tags":[],"yoast_head":"\n<\/span>Outcome Bias and the Retrospectoscope<\/span><\/h2>\n
<\/span>System 1 vs. System 2<\/span><\/h2>\n