Learning Clinical Reasoning,9780683045376

Learning Clinical Reasoning

by ;
ISBN13: 9780683045376
ISBN10: 0683045377
Format: Paperback
Pub. Date: 1991-05-01
Publisher(s): Williams & Wilkins
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Summary

Tufts University School of Medicine, Boston, Massachusetts. Textbook of diagnosis for medical students; includes case presentations. DNLM: 1. Cognition.

Table of Contents

Foreword vii
Samuel O. Thier
Harry R. Kimball
Preface ix
Acknowledgments xi
A Note About the Book's Format xiii
Part I. The Processes of Clinical Reasoning
Overview
2(5)
Introduction
Diagnosis is an inferential process
Problem-solving strategies
The nature and function of diagnostic hypotheses
Toward a working diagnosis
Therapeutic principles
Linking diagnosis and treatment
Diagnostic Hypothesis Generation
7(4)
Hypotheses and cues
The cognitive basis of hypothesis generation
Hypotheses as a context
Expertise and error
Refinement of Diagnostic Hypotheses
11(6)
Where refinement begins and ends
Context and diagnostic classification
Hypothesis evolution
Sequence of data collection
Reducing diagnostic entropy
The differential diagnosis
Relation to formal probabilistic approach
Use and Interpretation of Diagnostic Tests
17(11)
The function of tests
Quantifying testing decisions
Sensitivity and specificity
Bayes' rule
Testing principles
Bayesian revision for multiple diseases with multiple attributes
Pragmatic considerations in the probabilistic approach
Interpreting results
When to test
The threshold concept
The therapeutic threshold
Testing thresholds
Causal Reasoning
28(4)
Definition
A detailed example
Using a causal model
Where in the diagnostic process does causal reasoning fit?
Explaining relations between variables
Diagnostic Verification
32(2)
Definition
Criteria of validity
Premature closure
The penultimate result: a working diagnosis
Therapeutic Decision Making
34(3)
Principles
Treatment under conditions of uncertainty
When the value of therapeutic choices is close
Incommensurate options
Quantitative therapeutic decision making
Cognitive Errors
37(3)
Classification
Many errors are not strictly cognitive
The nature of cognitive errors
Cognitive biases in the laboratory
Consequences of cognitive biases
Some Cognitive Concepts
40(3)
Cognitive science
Studying mental processes
The structure of memory
Search strategies
Characteristics of expertise
Learning Clinical Problem Solving
43(5)
Facts vs. process
Pedagogic principles
A specific example
Learning by instantiation
Learning clinical problem solving vs. problem-based learning
Part II. Cognition at the Bedside: A Set of Examples
Introduction to the Cases
48(1)
Diagnostic Hypothesis Generation
49(22)
Generation of diagnostic hypotheses
Hypothesis triggering by an expert
A quick and accurate solution
A modern medical Descartes
A hit after a miss
Better late than never
Refinement of Diagnostic Hypotheses
71(53)
The critical role of context in the diagnostic process
Strategies of information gathering
A fatal flaw in Sutton's law
Narrowing down the diagnostic options
An orderly, sequential approach
Red herrings in the history
A picture is worth a thousand words
Distinguishing among competing hypotheses
Separating the wheat from the chaff
What is a differential diagnosis?
Discrimination: The problem of look-alikes
Tolerating uncertainty
Use and Interpretation of Diagnostic Tests
124(47)
Searching for a pony
It's what you believe that counts
Interpreting negative test results
All that glisters is not gold
Renal rescue by Reverend Bayes
An autopsy of the clinical reasoning process
Surprise!
Tripping over technology
Short-circuiting the diagnostic process
The bypass on the way to the bypass
A diagnostic fluke
The probability of a probability
Causal Reasoning
171(16)
The case for causal reasoning
Judging causality
Post hoc, ergo propter hoc
The right answer for the wrong reason
Diagnostic Verification
187(24)
Verification
Leaving no stone unturned
A meticulous approach
A diagnostic quandary
Diagnosis by fiat
Iron pyrite and diagnostic confirmation
Therapeutic Decision Making
211(22)
The surgeon opts to operate: Why?
A seemingly simple decision
Treat or keep testing?
Watch and wait or operate?
An apple or an orange?
A test of clinical judgment
Cognitive Errors
233(22)
Remedies for faulty hypothesis generation
A defective detective
Derailed by the availability heuristic
Wrong diagnosis, wrong tests, wrong treatment
Some Cognitive Concepts
255(37)
A message about methods
Intuitive and inspirational, or inductive and incremental?
Searching for solutions
Memory: How we overcome its limitations
Diagnosis and the structure of memory
Disease polymorphism and mental models
Diagnosis and the structure of memory
Exemplars, scripts, and simulation
Knowledge and clinical expertise
Cognition and connectionism
Learning Clinical Problem Solving
292(27)
The luxuriant language of diagnosis
Clinical cognition 101
Learning clinical reasoning from examples
Making a silk purse out of a sow's ear
Clinical problem solving at Grand Rounds
Glossary 319(6)
Index 325

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