Institute: ONC | Component: 2 | Unit: 4 | Lecture: c | Slide: 5
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:Techniques for Diagnosis Heuristics When you hear hoof beats, look for horses, not zebras Mathematics Bayes theorem Temporal patterns Acute, subacute, and so on Systematic e.g., VINDICATE: organ systems Anatomic e.g., chest anatomy Pathophysiologic e.g., bilirubin metabolism Pattern recognition e.g., NDM (naturalistic decision making) Mnemonic PT Barnum Loves Kids 5
Slide notes:This slide lists categories of techniques or processes that clinicians use to help them think about a diagnosis. These include systematic approaches that run through every organ system, such as the mnemonic [ ni - mon - ik ] vindicate. This memory aid helps students to remember diagnoses in a systematic fashion, in which V stands for vascular diseases, I for inflammatory diseases, N for neoplastic diseases, D for degenerative or deficiency diseases, I for idiopathic diseases and also for intoxications, C for congenital conditions, A for autoimmune or allergic diseases, T for traumatic events, and E for endocrine diseases. Another approach is the anatomic approach in which a clinician uses his or her knowledge of anatomy to think through the potential causes of the problem. For example, chest pain can result from a disorder in any number of structures, from the skin to the esophagus to the windpipe. Simply by thinking through this anatomy, a clinician can generate a fairly complete differential diagnosis of all the possible diseases that might cause chest pain. A third approach is pathophysiologic [ path -oh- fiz - ee -uh- la - jik ]. The clinician uses his or her knowledge of physiology to think through the potential causes of the problem. Another common approach is pattern recognition, which is used by clinicians who have sufficient experience with the condition to recognize that a particular case fits it or doesnt fit it. Other mnemonics may have nothing to do with the content but are helpful in remembering useful groupings. The mnemonic PT Barnum Loves Kids, for example, reminds the clinician that the causes of cancer that spread to the bone include prostate, thyroid, breast, lung, and kidney. Clinicians also make use of heuristics [ hyoo- ris -tiks ], such as the old saying When you hear hoof beats, look for horses, not zebras, which is a reminder to always think of the simplest explanation first. Clinicians sometimes make informal use of techniques based on Bayes [ bayz ] theorem, which can calculate the probability of a condition based on the findings that are present and the background probability of the condition. Finally, the temporal pattern of illness helps to explain the underlying pathophysiology [ path -oh- fiz - ee - ol -uh- jee ]. For example, the same symptoms occurring suddenly are likely to be caused by a different process than symptoms that evolve over months. 5