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Sharing Medicine
September 2017

Sharing the Process of Diagnostic Decision Making

Author Affiliations
  • 1Department of Internal Medicine, Eastern Virginia Medical School and Sentara Healthcare, Norfolk
  • 2Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
  • 3Department of Medicine, McGill University, Montreal, Quebec, Canada
JAMA Intern Med. 2017;177(9):1245-1246. doi:10.1001/jamainternmed.2017.1929

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.

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