Selecting clinical diagnoses: logical strategies informed by experience.

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Journal of Evaluation in Clinical Practice

MeSH Headings

Diagnosis; Physicians; Probability; Hypothesis; Adolescence; Female; Trochanteric Bursitis Diagnosis; Diagnosis, Differential; Vertebral Artery Dissections Diagnosis; Skin Diseases Diagnosis; Adult; Male; Lymphatic Diseases Diagnosis; Back Pain Diagnosis; Middle Age; Melena Diagnosis; Adolescent: 13-18 years; Adult: 19-44 years; Middle Aged: 45-64 years; Female; Male


This article describes reasoning strategies used by clinicians in different diagnostic circumstances and how these modes of inquiry may allow further insight into the evaluation and treatment of patients. Specifically, it aims to make explicit the implicit logical considerations that guide a variety of strategies in the diagnostic process, as exemplified in specific clinical cases. It focuses, in particular, in strategies that clinicians use to move from a large set of possible diagnoses initially suggested by abductive inferences - the process of hypothesis generation that creates a diagnostic space - to a narrower set or even to a single 'best' diagnosis, where the criteria to determine what is 'best' may differ according to different strategies. Experienced clinicians should have a diversified kit of strategies - for example, Bayesian probability or inference to a lovely explanation - to select from among previously generated hypotheses, rather than rely on any one approach every time.

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