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Comment & Response
November 6, 2018

Diagnostic vs Management Reasoning—Reply

Author Affiliations
  • 1Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine, Rochester, Minnesota
  • 2McMaster Education Research, Innovation and Theory (MERIT), McMaster University, Hamilton, Ontario, Canada
  • 3Division of Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
JAMA. 2018;320(17):1818-1819. doi:10.1001/jama.2018.13358

In Reply We welcome the opportunity to elaborate on the concept of management reasoning as discussed in our Viewpoint.1 We did not mean to imply that diagnostic reasoning and management reasoning are sequential. On the contrary, we agree that in practice, these typically occur in parallel and often influence one another.2 Indeed, naturalistic studies of clinical reasoning suggest that linear approaches, while attractive for superficial descriptions, do not match expert performance.3 Although the iterative nature of clinical reasoning may be particularly evident in time-pressured settings, such as intensive care units and emergency departments, we expect it is common across most clinical settings.