Information Analysis and Synthesis (critical thinking)

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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.

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