Learning Clinical Reasoning

2nd Edition

By: Jerome Kassirer , John Wong, Richard Kopelman

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Paperback | 9 November 2009 | Edition Number 2

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Paperback
352 Pages

Edition Type
Revised

Dimensions(cm)
25.4 x 17.7 x 1.1

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Learning Clinical Reasoning uses a case-based approach to teach students the basics of clinical reasoning.

The first section explains the chief components of the clinical reasoning process, such as generating and refining diagnostic hypotheses, using and interpreting diagnostic tests, assembling a working diagnosis, therapeutic decision-making, and examining and applying evidence, and also includes a discussion of cognitive errors.

The second section contains 69 cases in which clinicians "think out loud" about diagnostic and therapeutic dilemmas, and the authors critique these clinicians' reasoning.

This edition has thirty new cases from the New England Journal of Medicine and other sources and expanded discussions of evidence-based medicine, clinical practice guidelines, and cognitive errors.

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Foreword	p. vii
Preface to the Second Edition	p. ix
Acknowledgments	p. xiii
A Note About the Book's Format	p. xiv
The Processes of Clinical Reasoning
Overview	p. 3
Introduction	p. 3
Diagnosis is an Inferential Process	p. 5
Problem-Solving Strategies	p. 5
Diagnosis Based on Hypothesis Generation and Testing	p. 5
Alternate Concepts of Diagnostic Strategies	p. 6
Therapeutic Principles	p. 6
Linking Diagnosis and Treatment	p. 7
Diagnostic Hypothesis Generation	p. 8
Hypotheses and Cues	p. 8
The Cognitive Basis of Hypothesis Generation	p. 8
Hypotheses as a Context	p. 9
Expertise and Error	p. 9
Refinement of Diagnostic Hypotheses	p. 11
Where Refinement Begins and Ends	p. 11
Context and Diagnostic Classification	p. 11
Hypothesis Evolution	p. 12
Sequence of Data Collection	p. 12
Reducing Diagnostic Uncertainty	p. 13
The Differential Diagnosis	p. 14
Relation to Formal Probabilistic Approach	p. 14
Use and Interpretation of Diagnostic Tests	p. 15
The Function of Tests	p. 15
Quantifying Testing Decisions	p. 15
Sensitivity and Specificity	p. 16
Bayes' Rule	p. 17
Testing Principles	p. 18
Bayesian Revision for Multiple Results	p. 19
Bayesian Revision for Multiple Diseases With Multiple Attributes	p. 21
Pragmatic Considerations in the Probabilistic Approach	p. 22
Interpreting Results	p. 23
When to Test	p. 23
The Threshold Concept	p. 24
The Therapeutic Threshold	p. 24
Testing Thresholds	p. 25
Causal Reasoning	p. 28
Definition	p. 28
Using a Causal Model	p. 29
Where in the Diagnostic Process Does Causal Reasoning Fit?	p. 29
Explaining Relations Between Variables	p. 30
Diagnostic Verification	p. 31
Definition	p. 31
Criteria of Validity	p. 31
Premature Closure	p. 31
The Penultimate Result: A Working Diagnosis	p. 32
Therapeutic Decision Making	p. 33
Principles	p. 33
Treatment Under Conditions of Uncertainty	p. 33
When the Value of Therapeutic Choices is Close	p. 34
Incommensurate Options	p. 34
Quantitative Therapeutic Decision Making	p. 34
Examining Evidence	p. 36
Introduction	p. 36
Evidence-Based Medicine	p. 36
Asking Questions	p. 36
Searching for Evidence	p. 37
Summarizing and Appraising Evidence	p. 37
Applying the Evidence	p. 37
Practice Guidelines	p. 38
Cognitive Errors	p. 39
Scope	p. 39
Classification	p. 39
Some Errors may have a Psychological Origin	p. 39
The Nature of Cognitive Errors	p. 39
Cognitive Biases in the Laboratory	p. 40
Consequences of Cognitive Biases	p. 40
Strategies for Avoiding Cognitive Errors	p. 41
Some Cognitive Concepts	p. 42
Cognitive Science	p. 42
Studying Mental Processes	p. 42
The Structure of Memory	p. 42
Search Strategies	p. 44
Characteristics of Expertise	p. 46
Learning Clinical Problem Solving	p. 48
Facts Versus Process	p. 48
Pedagogic Principles	p. 49
A Specific Example	p. 49
The Goal Should Determine the Format	p. 50
Learning by Instantiation	p. 50
Learning Clinical Problem Solving Versus Problem-Based Learning	p. 51
Cognition at the Bedside: A Set of Examples
Introduction to the Cases	p. 55
Diagnostic Hypothesis Generation	p. 56
Generation of Diagnostic Hypotheses	p. 56
Hypothesis Triggering by an Expert	p. 60
A Diagnostic Coup	p. 63
A Quick and Accurate Solution	p. 66
Better Late Than Never	p. 69
A Hit After a Miss	p. 73
The Critical Role of Context in the Diagnostic Process	p. 76
A Masked Marauder	p. 81
A Serious Lack of Focus	p. 84
Refinement of Diagnostic Hypotheses	p. 89
What is a Differential Diagnosis?	p. 89
An Orderly, Sequential Approach	p. 94
Weak Reasoning: Diagnosis by Drug Reaction	p. 96
Narrowing Down the Diagnostic Options	p. 100
A Picture is Worth a Thousand Words	p. 104
Strategies of Information Gathering	p. 108
A Fatal Flaw in Sutton's Law	p. 113
How to Disregard Red Herrings	p. 118
Discrimination: The Problem of Look-Alikes	p. 121
Location, Location, Location	p. 125
Use and Interpretation of Diagnostic Tests	p. 128
Interpreting a Negative Test Result	p. 128
Diagnosis and the Risks of the Primrose Path	p. 131
Searching for a Pony	p. 134
Interpreting Hoofbeats: Can Bayes Help Clear the Haze?	p. 137
Short-Circuiting the Diagnostic Process	p. 143
The Bypass on the Way to the Bypass	p. 145
It is What You Believe That Counts	p. 148
Renal Rescue by Reverend Bayes	p. 152
A Diagnostic Fluke	p. 155
Surprise!	p. 157
Tripping Over Technology	p. 161
The Probability of a Probability	p. 165
Causal Reasoning	p. 169
Judging Causality	p. 169
Post Hoc, Ergo Propter Hoc	p. 171
The Case for Causal Reasoning	p. 175
The Tricky Task of Attributing Causation	p. 180
The Right Answer for the Wrong Reason	p. 183
Diagnostic Verification	p. 186
A Point-By-Point Dissection of Clinical Reasoning	p. 186
Leaving No Stone Unturned	p. 188
Verification	p. 192
A Meticulous Approach	p. 196
A Diagnostic Quandary	p. 199
Diagnosis by Fiat	p. 203
Iron Pyrite and Diagnostic Confirmation	p. 207
Therapeutic Decision Making	p. 209
The Surgeon Opts to Operate: Why?	p. 209
Treat or Keep Testing?	p. 211
Watch and Wait, or Operate?	p. 216
An Apple or an Orange?	p. 218
Examining Evidence	p. 223
A Difficult Tradeoff	p. 223
Making Judgments When the Evidence is Not Definitive	p. 225
Using and Citing Published Evidence	p. 227
A Little Math Makes the Medicine Go Down	p. 229
A Rewarding Pursuit of Certainty	p. 234
Treating Before Knowing	p. 239
Cognitive Errors	p. 244
A Defective Detective	p. 244
Remedies for Faulty Hypothesis Generation	p. 248
A Disaster Averted	p. 252
Derailed by the Availability Heuristic	p. 255
Wrong Diagnosis, Wrong Tests, Wrong Treatment	p. 262
Reconsidering Failures of Therapy	p. 266
The Cheetah and the Snail	p. 267
A Collection of Cognitive Diagnostic Errors	p. 271
Some Cognitive Concepts	p. 275
A Message about Methods	p. 275
Memory: How We Overcome its Limitations	p. 279
Diagnosis and the Structure of Memory; Disease Polymorphism and Mental Models	p. 281
Intuitive and Inspirational, or Inductive and Incremental?	p. 286
Knowledge and Clinical Expertise	p. 291
Learning Clinical Problem Solving	p. 295
Learning Clinical Reasoning from Examples	p. 295
Making a Silk Purse out of a Sow's Ear	p. 299
Optimizing Case Discussions	p. 304
Glossary	p. 308
Bibliography	p. 313
Index	p. 325
Table of Contents provided by Ingram. All Rights Reserved.

Learning Clinical Reasoning

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