Reasoning strategies

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  • 1. Hypothetico-deductive (backward) reasoning
  • 2. Algorithmic (forward) reasoning
  • 3. Pattern recognition
    • Expert diagnosticians tend to use pattern recognition and algorithmic thinking, but return to hypothetico-deductive reasoning if the first two strategies are unsuccessful. Novice clinical reasoners tend to use hypothetico-deductive reasoning more often than the other strategies.
  • http://en.wikipedia.org/wiki/Occam
    • When you have two competing theories that make exactly the same predictions, the simpler one is the better
  • http://en.wikipedia.org/wiki/Sutton's_law
    • Go where the money is
    • Consider the most likely conditions that the patient might have and do those tests first that have the highest liklihood of making the diagnosis the quickest and at the least expense
    • Negative finding in a test with a high sensitivity rules out a diagnosis
    • Positive finding in a test with a high specificity rules in a diagnosis

<<< NEJM: http://content.nejm.org/cgi/content/extract/355/21/2217 http://www.im.org/Publications/PhysiciansInTraining/Documents/Primer2ndEd.pdf http://www.geocities.com/davidscerri/contents.html http://en.diagnosispro.com/differential_diagnosis/home/ http://www.accessmedicine.com/diag.aspx BMJ 2009;338:b1860: http://www.bmj.com/cgi/content/full/338/jun08_2/b1860?view=long&pmid=19505957 Kaohsiung J Med Sci 2008;24:341: http://ajws.elsevier.com/ajws3/abstract.asp?art_id=4564&art_journals=1 <<<