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
- General appearance
- Nature and duration of symptoms
- Identify abnormal findings
- Localise findings anatomically
- Interpret findings in terms of probable process
- Make hypothesis about nature of patient’s problem – differential diagnoses
- Test the hypothesis and establish a working diagnosis
- Develop a plan agreeable with the patient
The Advanced Life Support (ALS) approach
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/
Developed by experts, based on pooled experience and current knowledge (eg Wells scoring).
Mnemonics help us to consider all the key options for that presentation. For example:
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).
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
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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