STUCK IN A RUT? THINKING ABOUT THINKING…..

 “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

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

HOW DO WE DIAGNOSE DISEASE?

DIAGNOSTIC PROCESSES  Pattern recognition  Hypothetico-deductive reasoning  Information gathering

WHAT SKILLS DO WE NEED?

SKILLS NEEDED FOR CORRECT DIAGNOSIS  Disease knowledge base  Communication skills  Examination skills  Diagnostic reasoning skills  Organisational skills

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

Heuristics are short-cuts or rules of thumb that we use in problem solving…  We all use them, all the time but probably aren’t 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…..

MEANS-END ANALYSIS  The ability to look ahead to a possible diagnosis and structure history, examination and investigation accordingly.

ANTI-LOOPING HEURISTIC  This represents our reluctance to re-analyse data, re-order tests, reconsider previously discarded diagnoses as we don’t 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

ANCHORING This has good and bad points  On the bad side…if we don’t “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 side…common things ARE common

AVAILABILITY We probably use this a lot without realising…  If you’ve just seen a case of Lyme Disease you’re more likely to consider this as a differential in that facial palsy that’s actually Bell’s  That patient with a fever must have Swine Flu because the newspapers say it is rife  A patient might argue that smoking isn’t bad for you because his Gran smokes and she’s 100 today

SOME SIMPLE HEURISTICS WE USE  Red flags  Time  Any more…..?