Information Analysis and Synthesis (critical thinking)
The diagnostic process is complex – the relevant is seperated from irrelevant objectively evaluated logical analysis and interpretation diagnosis or differential diagnosis
Before interpretation of clinical signs and symptoms consider:
• the reliability of the clinical test
• the sensitivity and specificity of the clinical test
• the validity of the assumption of what underpins the test
There may have been some constraints that may have prevented the patient from being entirely straightforward/honest/forthcoming in their account of the presenting complaint, history and physical findings (eg embarrassment; do not have vocabulary or prior experiences to fully verbalise what they are feeling; responding to leading questions in a way to give the answer they think the clinician wants).
Clinical impression and findings are recorded in the notes and communicated to the patient. Problems identified solutions proposed
Four strategies can be used for reaching diagnoses :
1) Pattern recognition – this is the instance realisation that the patients presenting clinical features confirm to a previously learned pattern (eg the pain upon arising of plantar fasciitis)
2) Arborisation using algorithms – the diagnostic process progresses down one of a large number of possible pathways. The response to one inquiry, determines the next inquiry diagnosis is reached
3) Exhaustive – all the data from the history and physical is collected. Once this stage is complete, the data is searched for the diagnosis
4) Hypothetico-deductive – from the early clues, a short list of potential diagnoses is drawn up inquiries are aimed at ruling in or out the potential diagnosis.
A summary of no more than a few sentences should identify the patients major problems – only the pertinent information should be included problem list developed management plan and goals.