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Give us a clue!

Having discussed your own process for solving a clinical problem, we will now look at some common strategies for problem-solving and clinical decision-making.

The process of clinical decision-making: elements of diagnosis

  1. General appearance
  2. Nature and duration of symptoms
  3. Identify abnormal findings
  4. Localise findings anatomically
  5. Interpret findings in terms of probable process
  6. Make hypothesis about nature of patient’s problem – differential diagnoses
  7. Test the hypothesis and establish a working diagnosis
  8. Develop a plan agreeable with the patient

Common strategies

The Advanced Life Support (ALS) approach

Primary survey
A – Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure

For full details of this approach, you can visit https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/

Decision rules

Developed by experts, based on pooled experience and current knowledge (eg Wells scoring).

Checklists

Mnemonics help us to consider all the key options for that presentation. For example:

TICOSMO POSHPATE
Trauma Problem
Infection Onset
Chemicals Symptoms
Organs History
Stress Precipitating factors
Musculoskeletal Alleviating/aggravating factors
Other Timing
  Etiology

Hypothetical-deductive reasoning

This is appropriate for well-defined problems, but not appropriate for complex problems (eg from the history, my hypothesis is that the patient most likely has heart disease. I will perform a physical examination and laboratory tests to confirm this, and to rule out differential diagnoses).

Pattern recognition

We compare this case to others we have seen, grouping clinical factors into patterns from our experience (e.g. chicken pox, Colles’ fracture).

Some relevant maxims

  • True disease presents itself
  • Common diseases occur commonly, rare diseases occur rarely!
  • Don’t forget the history!
  • Do the necessary physical examination

Your task

Now consider another clinical decision-making strategy that you are aware of, or have used.

Post the name or the link to the strategy and list its advantages or disadvantages.


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This article is from the free online course:

An Introduction to Physical Health Assessment

Coventry University