Institute: ONC | Component: 2 | Unit: 4 | Lecture: b | Slide: 6
Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Health Care Processes and Decision Making
Lecture:Gathering data and analyzing findings Making a diagnosis The impact of EHRs and technology on clinical decision-making
Slide content:Clinical Process: The Reality 4.5 Chart: Depiction of an iterative reasoning clinical process 6
Slide notes:Because the complete history and physical is not really linear and orderly, clinicians often employ an iterative hypothetico -deductive [hi- puh - thet - i - koh -dee- duhkt -iv] reasoning process. In this process, the experiences reported by the patient, which are called symptoms , and the observations made by the clinician, which are called signs , are gathered simultaneously, not one after the other in a linear fashion. Furthermore, making sense of this information, assessing it, and formulating hypotheses about it, begin not after gathering all the data but within a very short time after the initial process beginsin as little as 20 or 30 seconds. Symptoms and signs are uncovered, and a set of working candidate diagnoses are considered. These hypotheses are then tested with further questioning, which can eliminate some or corroborate others. The process proceeds in an iterative hypothesis-testing cycle until enough certainty has been reached that the clinician can take action. Elstein [ el - steen ] described some of the cognitive properties of this process, such as narrowing of the cognitive space of possibilities. For simplicity, however, its sufficient to say that the clinician uses an iterative, cyclical process of information gathering and assessment that doesnt follow the linear, orderly sequence noted earlier. This nonlinear process has implications for the development of information systems, which should function as a support tool for clinicians during this iterative patient data collection process. Information systems should ideally be flexible to support the clinicians practices, processes, and workflow. They should function as an effective tool that captures, displays, and reports patient data in a manner to facilitate clinical practice with the assessment, diagnoses, and treatment of patients. 6