STUCK IN A RUT

1
STUCK IN A RUT?

• THINKING ABOUT THINKING..

2

• The three main tasks of the clinician are
  diagnosis, prognosis and treatment. Of these,
  diagnosis is by far the most important for upon
  it the success of the other two depend
• 
  J A Ryle

3
SESSION PLAN and AIMS

• Explore, briefly, the diagnostic process
• Small group problem solving session
• Solutions to problems
• Introduction to heuristic learning theory
• At the end of the session you should have an
  understanding of how heuristic learning theory
  may inform/influence your clinical practice

4
HOW DO WE DIAGNOSE DISEASE?
5
DIAGNOSTIC PROCESSES

• Pattern recognition
• Hypothetico-deductive reasoning
• Information gathering

6
WHAT SKILLS DO WE NEED?
7
SKILLS NEEDED FOR CORRECT DIAGNOSIS

• Disease knowledge base
• Communication skills
• Examination skills
• Diagnostic reasoning skills
• Organisational skills

8
DIAGNOSTIC REASONING SKILLS

• Ability to assess baseline probability of disease
• Understanding of diagnosticity of symptoms,signs
  and tests
• Ability to recognise new symptoms and signs and
  revise diagnosis
• Ability to use diagnostic heuristics

9
Heuristics are short-cuts or rules of thumb that
we use in problem solving

• We all use them, all the time but probably arent
  aware we are doing it
• Heuristics are often the difference between
  experienced doctors and those that are more
  junior
• Heuristics may aid rapid, accurate diagnosis but
  they can also be the source of error
• More of this later..

10
MEANS-END ANALYSIS

• The ability to look ahead to a possible diagnosis
  and structure history, examination and
  investigation accordingly.

11
ANTI-LOOPING HEURISTIC

• This represents our reluctance to re-analyse
  data, re-order tests, reconsider previously
  discarded diagnoses as we dont like to feel we
  are taking backward steps instead of advancing
• Recognising this reluctance in ourselves enables
  us to be aware when it occurs and take steps to
  counteract it

12
ANCHORING

• This has good and bad points
• On the bad sideif we dont think outside the
  box sometimes we might miss those more obscure
  diagnoses
• We may rely too heavily on one piece of info
• On the good sidecommon things ARE common

13
AVAILABILITY

• We probably use this a lot without realising
• If youve just seen a case of Lyme Disease youre
  more likely to consider this as a differential in
  that facial palsy thats actually Bells
• That patient with a fever must have Swine Flu
  because the newspapers say it is rife
• A patient might argue that smoking isnt bad for
  you because his Gran smokes and shes 100 today

14
SOME SIMPLE HEURISTICS WE USE

• Red flags
• Time
• Any more..?

15
(No Transcript)