Understanding diagnostic excellence

When we think about clinical reasoning, most talks focus on diagnostic errors and the reasons for those errors. The legacy of Kahneman and Tversky focuses on errors and the many named mistakes we make. We focus on avoiding errors, but their work and too often our teaching does not focus on the road to diagnostic excellence. Gary Klein, the pioneer of naturalistic decision making, has focused more on the road to excellence. These are not two sides of a coin, but rather separate important concepts for us to understand. The road to excellence is likely more challenging than the road to avoiding errors. The road to excellence develops “instincts” and type 1 reasoning. The excellent diagnostician feels uncomfortable first, and then can explain why. That diagnostician must resolve the uncomfortable feeling. The problem arises from the complexity of human beings, interviewing skills, physical diagnosis and test interpretation. As I reconstruct my best diagnostic coups, the road to the correct diagnosis is rarely straight. Each diagnostic triumph takes a different looking path. The first step towards diagnostic excellence requires an understanding that the simple assumptions (or at least previous assumptions) might need revisiting. Once we recognize the need to reconsider the diagnosis, then we have to use many skills. Experts attack the diagnostic process like jazz artists attack a musical performance. In order to be a great jazz musician, you must first mast...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs