Learning Clinical Reasoning

Cover
Learning Clinical Reasoning, Second Edition
Copyright
Dedication
Foreword
Preface to the Second Edition
Acknowledgments
A Note About the Book’s Format
Contents
Part I: The Processes of Clinical Reasoning
Chapter 1: Overview
Introduction
Diagnosis is an Inferential Process
Problem-Solving Strategies
Diagnosis Based on Hypothesis Generation and Testing
Alternate Concepts of Diagnostic Strategies
Linking Diagnosis and Treatment
Chapter 2: Diagnostic Hypothesis Generation
Hypotheses and Cues
The Cognitive Basis of Hypothesis Generation
Hypotheses as a Context
Expertise and Error
Chapter 3: Refinement of Diagnostic Hypotheses
Where Refinement Begins and Ends
Context and Diagnostic Classification
Hypothesis Evolution
Sequence of Data Collection
Reducing Diagnostic Uncertainty
The Differential Diagnosis
Relation to Formal Probabilistic Approach
Chapter 4: Use and Interpretation of Diagnostic Tests
The Function of Tests
Quantifying Testing Decisions
Sensitivity and Specificity
Bayes' Rule
Testing Principles
Bayesian Revision for Multiple Results
Bayesian Revision for Multiple Diseases With Multiple Attributes
Pragmatic Considerations in the Probabilistic Approach
Interpreting Results
When to Test
The Threshold Concept
The Therapeutic Threshold
Testing Thresholds
Chapter 5: Causal Reasoning
Definition
Using a Causal Model
Where in the Diagnostic Process Does Causal Reasoning Fit?
Explaining Relations Between Variables
Chapter 6: Diagnostic Verification
Definition
Criteria of Validity
Premature Closure
The Penultimate Result: A Working Diagnosis
Chapter 7: Therapeutic Decision Making
Principles
Treatment Under Conditions of Uncertainty
When the Value of Therapeutic Choices is Close
Incommensurate Options
Quantitative Therapeutic Decision Making
Chapter 8: Examining Evidence
Introduction
Evidence-Based Medicine
Asking Questions
Searching for Evidence
Summarizing and Appraising Evidence
Applying the Evidence
Practice Guidelines
Chapter 9: Cognitive Errors
Scope
Classification
Some Errors may have a Psychological Origin
The Nature of Cognitive Errors
Cognitive Biases in the Laboratory
Consequences of Cognitive Biases
Strategies for Avoiding Cognitive Errors
Chapter 10: Some Cognitive Concepts
Cognitive Science
Studying Mental Processes
The Structure of Memory
Search Strategies
Characteristics of Expertise
Chapter 11: Learning Clinical Problem Solving
Facts Versus Process
Pedagogic Principles
A Specific Example
The Goal Should Determine the Format
Learning by Instantiation
Learning Clinical Problem Solving Versus Problem-Based Learning
Part II: Cognition at the Bedside: A Set of Examples
Chapter 12: Introduction to the Cases
Chapter 13: Diagnostic Hypothesis Generation
Case 1. Generation of Diagnostic Hypotheses
Case 2. Hypothesis Triggering by an Expert
Case 3. A Diagnostic Coup
Case 4. A Quick and Accurate Solution
Case 5. Better Late Than Never
Case 6. A Hit After a Miss
Case 7. The Critical Role of Context in the Diagnostic Process
Case 8. A Masked Marauder*
Case 9. A Serious Lack of Focus
Chapter 14: Refinement of Diagnostic Hypotheses
Case 10. What is a Differential Diagnosis?
Case 11. An Orderly, Sequential Approach
Case 12. Weak Reasoning: Diagnosis by Drug Reaction*
Case 13. Narrowing Down the Diagnostic Options
Case 14. A Picture is Worth a Thousand Words
Case 15. Strategies of Information Gathering
Case 16. A Fatal Flaw in Sutton's Law
Case 17. How to Disregard Red Herrings
Case 18. Discrimination: The Problem of Look-Alikes
Case 19. Location, Location, Location
Chapter 15: Use and Interpretation of Diagnostic Tests
Case 20. Interpreting a Negative Test Result
Case 21. Diagnosis and the Risks of the Primrose Path
Case 22. Searching for a Pony
Case 23. Interpreting Hoofbeats: Can Bayes Help Clear the Haze?*
Case 24. Short-Circuiting the Diagnostic Process
Case 25. The Bypass on the Way to the Bypass
Case 26. It is What You Believe That Counts
Case 27. Renal Rescue by Reverend Bayes
Case 28. A Diagnostic Fluke
Case 29. Surprise!
Case 30. Tripping Over Technology
Case 31. The Probability of a Probability
Chapter 16: Causal Reasoning
Case 32. Judging Causality
Case 33. Post Hoc, Ergo Propter Hoc
Case 34. The Case for Causal Reasoning
Case 35. The Tricky Task of Attributing Causation
Case 36. The Right Answer for the Wrong Reason
Chapter 17: Diagnostic Verification
Case 37. A Point-By-Point Dissection of Clinical Reasoning
Case 38. Leaving No Stone Unturned
Case 39. Verification
Case 40. A Meticulous Approach
Case 41. A Diagnostic Quandary
Case 42. Diagnosis by Fiat
Case 43. Iron Pyrite and Diagnostic Confirmation
Chapter 18: Therapeutic Decision Making
Case 44. The Surgeon Opts to Operate: Why?
Case 45. Treat or Keep Testing?
Case 46. Watch and Wait, or Operate?
Case 47. An Apple or an Orange?
Chapter 19: Examining Evidence
Case 48. A Difficult Tradeoff
Case 49. Making Judgments When the Evidence is Not Definitive
Case 50. Using and Citing Published Evidence
Case 51. A Little Math Makes the Medicine Go Down*
Case 52. A Rewarding Pursuit of Certainty*
Case 53. Treating Before Knowing*
Chapter 20: Cognitive Errors
Case 54. A Defective Detective
Case 55. Remedies for Faulty Hypothesis Generation
Case 56. A Disaster Averted
Case 57. Derailed by the Availability Heuristic
Case 58. Wrong Diagnosis, Wrong Tests, Wrong Treatment
Case 59. Reconsidering Failures of Therapy
Case 60. The Cheetah and the Snail
Case 61. A Collection of Cognitive Diagnostic Errors
Chapter 21: Some Cognitive Concepts
Case 62. A Message about Methods
Case 63. Memory: How We Overcome its Limitations
Case 64. Diagnosis and the Structure of Memory; Disease Polymorphism and Mental Models
Case 65. Intuitive and Inspirational, or Inductive and Incremental?
Case 66. Knowledge and Clinical Expertise
Chapter 22: Learning Clinical Problem Solving
Case 67. Learning Clinical Reasoning from Examples
Case 68. Making a Silk Purse out of a Sow's Ear
Case 69. Optimizing Case Discussions
Glossary
Bibliography
Index