1. Problem Solving Skills
Behavioural Sciences
Mr Lema
HKMU MD1 & BScN 1
Group 16
Ally Msigiti Salimu
Juvenarius Kirango Anselm
Danielle Dann
Shadrack Elia Makanda
Elizabeth Peter Joseph
Hiltruda Julius Kimario
Firdaus Nassor Ali
Sifa Rajabu
Irene Frank Shirima

2. Problem solving is essential in medical practice due to the following:
1. Unique difficulties in diagnosing disease, especially at early onset, or with out specialised hospital units or investigation facilities.
2. multiple problems: How to prioritise
3. Methods of disease, so mitigation against future problems.
Introduction

3. What is a Problem? A problem is defined as:
a situation, person, or thing that needs attention and needs to be dealt with or solved. (Cambridge Dictionary, 2016)
What is a Problem?

4. Two examples of Problem Solving techniques:
Flow chart based
7 questions based
Two examples of Problem Solving techniques:

5. Problem solving Different cues Different prevalence
Different predictive value of tests at early stages
Serial versus parallel testing ( ie, over a course of time)
Problem solving

6. Patient complains of tiredness: What are the most likely causes?
20 y/o female
45 y/o male
55 y/o female
65 y/o male

7. Diagnostic process Presenting cues Gather information
Gather info with a purpose
Gather information
Directed search
Selective tests
Interpret information
Gather more information
Hypothetico-deductive reasoning:
Forms diagnosis or hypotheses
Diagnostic process

8. Flow chart approach Using existing info:
Patient demography, age, sex, ethnicity, education, occupation
Past medical history
Lifestyle
Health perception
Combine with:
New observations:
Change of function of activities
Adverse life events
Unusual presentations
Main concerns of patient during consultation
Flow chart approach

9. Triangle of preliminary Assessement
Existing info
New observations
Presenting complaints
Triangle of preliminary Assessement

10. Presenting complaints
Existing info
New observations
Presenting complaints
What are your preliminary assessments?
Provisional Diagnosis or Hypotheses

11. Prefrom necessary clinical examinations/investigations
Differential diagnosis
Appropriate management/advice

12. Triangle of preliminary assessment
Re-assessment
Problem persists
Improvement
review
Triangle of preliminary assessment

13. Diagnostic process PST APPROACH Probability- most likely
Seriousness- most serious
Treatability- should not be missed
Diagnostic process

14. Problem Solving- question based

15. Comprehension space This is where a person makes sense of problems.
There are aspects that need to be considered, such as:
How is the problem presented? How it is worded will influence how you will solve it: for example, a plan that is 60% successful sounds preferable to a plan that will lose a 1/3rd.
Time available
Seriousness of situation
Expectations put on the decision maker, eg patient, doctor relationship.
Comprehension space

16. Comprehension Space cont..
Problem types:
Simplistic: only one answer, eg a closed question
Deterministic problems: where the answer is met by a formula, eg math problems, or laboratory tests: sugar in Urine or not
Random problems: there is only one answer but there are a number of possible correct answers: Eg, multiple choice questions or even, does this patient have a high Uric acid serum concentration, what is the cause.
Comprehension Space cont..

17. Indeterminate problems: the answer is complex, hard to identify or changes in time:
Problem types cont..

18. Identify the problem type: then apply problem solving process.
Avoid congnitive biases. (Tversky, Kahneman, 1972) This is where decisions are made based on experience, memory, recent exposure motivations, confirmations, (ie, I want it to be this answer and this evidence confirms my beliefs)
Problem solving

19. This is where you analyse the evidence and work your way through the problem. For this to be efficient, a problem solving tool is recommended. This helps you identify criteria to help justify and explain your decision.
The problem space

20. 7 questions What is the situation and how does it affect me?
What have I been told to do and why
What effects do I need to achieve and what instruction must I give to develop my plan
Where can I best accomplish each action/effect?
What resources do I need to accomplish each action/effect?
When and where do the actions take place in relation to each other?
What control measures do I need to impose?
7 questions

21. 1. What are the stress factors on me completing the task
1. What are the stress factors on me completing the task? Time frame, priorities, other influencing factors? Eg a patient has a list of symptoms, how do you choose which to address first
2. understand the reasoning behind the problem. What depends on you successfully completing it. Who do you need to involve to achieve a solution?
3. Clear communications with anyone supporting your task is crucial. Eg, nurse, lab, pharmacist, secondary medical care.
4. Knowing who is the best person to refer to, who can achieve what you need to solve the problem, which lab, which specialist, etc.
5. What is your resource pool. What do you have accesss to? Which lab tests to confirm diagnosis, cost, available staff
6. Do you need to book a theatre? Do you need to consider extra treatment. Which tests need to be done first? Is there a priority list?
7. How much management do you need to impose. Do you need to chase up results? Do you need to set time frames? Eg, come back in 2 days, come back in 7 days. etc
7 questions explained

22. People fail to find effective solutions due to various factors such as lack of commitment to solve the problem,misinterpreting,lack of techniques and processes involved in problem solving and the inability to use the techniques effectively.
Treating problems as problems they are problems and treating problems as opportunities they are opportunities.
Conclusion

23. questions?

24. Kingman, D & Tversky, A ( 1972) “subjective probability: A judgement of representativeness”, Cognitive Psychology 3:
Prof Albert Lee- Family Medicine, Chinese University of Hong Kong.
Updated 1 October 2015
References