When a patient comes to see a physician, the patient often asks, “Doctor, what is happening to me?” Through experience, the clinician knows how to proceed and guides the patient through a process that, if all goes well, will yield an accurate diagnosis. This process can be improved through a refinement of diagnostic thinking on the part of the clinician, which in turn can help to guide choices by patients.
The process of making a medical diagnosis was studied in the 1970s in a landmark study by Elstein et al.1(pp10-45) These investigators found that expert diagnosticians used a combination of intuitive and analytical thinking skills just like decision makers in other domains,2(pp234-244)3(pp65-79) and these skills allowed them to make a medical diagnosis through hypothesis generation and verification. Within minutes of starting a diagnostic inquiry, experts developed 3 to 5 hypotheses—conjectures or provisional diagnoses—that provided the starting point for making a medical diagnosis. Norman et al4 and others have shown that as physicians gain experience, the speed and accuracy of early hypothesis generation improves.
Brush JE, Brophy JM. Sharing the Process of Diagnostic Decision Making. JAMA Intern Med. 2017;177(9):1245–1246. doi:10.1001/jamainternmed.2017.1929
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