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November 22, 1985

Differential Diagnosis and Heuristics

Author Affiliations

Veterans Administration Medical Center Oregon Health Sciences University Portland

JAMA. 1985;254(20):2890. doi:10.1001/jama.1985.03360200040010

To the Editor.—  In their recent article Wolf et al1 assert that trainees should address uncertainty by searching for clinical manifestations regarding one disease as opposed to using a strategy permitting evaluation of symptoms and signs across multiple diseases. They reason that this is the result of the educational model that focuses on pathophysiological disease entities whereby the clinician has learned to recognize patterns and clusters. Although I do not necessarily disagree with their assertion or their study, I do prefer to reflect on these concepts according to two other models, previously addressed in the literature, both of which are descriptive and perhaps prescriptive in nature. In the first, Johnson et al2 discuss the "breadth" vs "depth" approaches. The breadth strategy enables the clinician to maintain consideration of all major hypotheses as evaluation proceeds, whereas in the depth strategy one hypothesis is considered until disconfirmed. Other labels for