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Society to Improve Diagnosis of Medicine: Link

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Clinical reasoning: Link

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Improving Diagnosis in Health Care: Link 

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Diagnosis:  Link

了解臨床推理必讀的案例報告 (出處: Journal of general internal medicine  )

1 Henderson, Mark C., Gurpreet Dhaliwal, Stephen R. Jones, Charles Culbertson, and Judith L. Bowen. “Doing what comes naturally.” Journal of general internal medicine 25, no. 1 (2010): 84-87. (案例重點The first exercise in the series. Introduces the concepts of problem representation and illness scripts.)

2.Bhatnagar, Deepa, Jason L. Morris, Martin Rodriguez, Robert M. Centor, Carlos    A.   Estrada, and Lisa L. Willett. “A middle-age woman with sudden onset dyspnea.” Journal of general internal medicine  26, no. 5 (2011): 551-554. (案例重點Discusses the concept of heuristics, demonstrating how they can lead to diagnostic errors.)

3 Anderson, Ivan B., Shiv Sudhakar, Craig R. Keenan, and Malathi Srinivasan. “The Elusive SIRS Diagnosis.” Journal of general internal medicine 28, no. 3 (2013): 470-474. (案例重點 Wide ranging reasoning discussion that includes problem representation/ illness scripts, heuristics, and pivot points. “Pivot points are conditions or symptoms that have a limited differential diagnosis, around which a clinical team can “pivot” their diagnostic thinking.” )

4 Schleifer, J. William, Robert M. Centor, Gustavo R. Heudebert, Carlos A. Estrada, and Jason L. Morris. “NSTEMI or not: a 59-year-old man with chest pain and troponin elevation.” Journal of general internal medicine 28, no. 4 (2013): 583-590. (案例重點 Dr. Gary Klein, leader in the field of naturalist decision making, proposed recognition-primed decision making. He focuses on the steps to expertise, rather than the causes of errors. This discussion highlights Klein’s greatest contribution – the pre-mortem examination. “In this approach, our expert imagines choosing a given diagnosis with its resultant treatment. The expert then mentally simulates the potential consequences. If the expert still has doubts because the mental simulation raises cautions, he will seek more information before committing to the diagnosis.”)

5 Cassese, Todd, Elizabeth Kaplan, Vanja Douglas, and Gurpreet Dhaliwal. “Getting to the Right Question.” Journal of general internal medicine 28, no. 9 (2013): 1242. (案例重點Uses problem representation and illness scripts to discuss a complex case. “The progression of the case illustrates how the key problem to be solved (embodied in the problem representation) can evolve rapidly.” One could easily use Klein’s RPDM in this discussion. As you study that model, Step 1 is pattern recognition. When data are missing, one goes to step 2, collects data, and then goes back to step 1. In this case, as more data become available, the problem representation becomes more specific, leading towards the correct diagnosis, and penultimately, the proper historical features.)

6 Jones, Benjamin, Walter Brzezinski, Carlos Estrada, Martin Rodriguez, and Ryan Kraemer. “A 22-Year-Old Woman with Abdominal Pain.” Journal of general internal medicine 7, no. 29 (2014): 1074-1078. (案例重點 A hallmark of the master diagnostician is familiarity with a large number of disorders, but extensive knowledge about every medical disorder is not possible or practical. These minutiae would clutter our brain attics and make useful information less easily retrievable. Instead, clinicians should develop detailed illness scripts for common conditions in their practice and maintain small illness scripts for disorders that, although uncommon, may still be encountered in their scope of practice—keeping this information in their brain attics for future use. A well-organized illness-script repertoire can allow a clinician to make a diagnosis that has gone unrecognized by others—a true hallmark of the master diagnostician.)

7 Martin, Marlene, Reza Sedighi Manesh, Mark C. Henderson, and Jeffrey M. Critchfield. “Diagnostic Scheming.” Journal of general internal medicine 30, no. 12 (2015): 1874-1878. (案例重點 Extends the concepts of problem representation with a discussion of diagnostic scheming. “Using inductive reasoning, a clinician applies a diagnostic scheme to a symptom, physical exam abnormality, laboratory value, or image finding. A scheme incorporates a decision tree approach that guides clinicians as they incorporate new data to build understanding of the entity. It is helpful, when pattern recognition is insufficient or as additional data emerges, to expand the scope of current diagnostic possibilities. Through repeated encounters with an illness or symptom, a clinician’s diagnostic scheme grows, particularly if grounded in intentional reflection of the outcomes of past decisions.”)

8 Small, Christopher, Andrew M. Land, Steven A. Haist, Carlos A. Estrada, and Erin D. Snyder. “Managing Cognitive Load to Uncover an Unusual Cause of Syncope: Exercises in Clinical Reasoning.” Journal of general internal medicine(2015): 1-5. (案例重點 Introduces the concept of cognitive load: “This case highlights cognitive load theory, as it can be applied to clinical medicine. Cognitive load theory discusses how working memory is strained by a particular problem, and outlines three types of load: intrinsic, extraneous, and germane. 3 Intrinsic load relates to the nature of the problem and the expertise of the problem solver. Extraneous load relates to how the problem is presented and increases with distractions from potentially irrelevant information; the vast amount of laboratory data in the case is an example. Finally, germane load is the necessary working memory power that is required for learning. These types of cognitive load may be considered to be additive, and each learner has a maximum amount of cognitive load possible that will still give room for the work required for learning, or germane load, to occur“