Teaching Clinical Reasoning at Medical School is unavoidable
I really do appreciate the article” Errors in clinical reasoning” by
Ian Scott , but I wonder, why it appeared so late. Clinical reasoning and
decision making is around for some time. The former NEJM editor Jerome
Kassirer published a series of case reports to try to make physician aware
of possible pitfalls of diagnosis and the continuous flow of the
diagnostic process and differential diagnosis over time.
Medical up-to-date and evidence - based -knowledge is very important for a
clinical diagnosis ,but the doctors personal features as mentioned in the
article and continuous self-reflection combined with self-criticism, Gut
feelings and patient centered attitude is paramount for good medical
practice. Karl Popper, a philosopher of science, says:
(1) The game of science is, in principle, without end. . . . .(2) Once a hypothesis has been proposed and tested, and has proved
its mettle, it may not be allowed to drop out without "good reason". A
"good reason" may be, for instance: replacement of the hypothesis by
another which is better testable; or the falsification of one of the
consequences of the hypothesis
Unfortunately medical schools teach contents rather than a structural
reflective approach to a diagnosis, despite Clinical reasoning being so
essential to the medical decision making process.
One would hope,that medical faculties will put more emphasis on clinical
reasoning within the curriculum and improve the treatment decision of
future doctors, so that a pregnant patient with a history of migraine
presenting with acute headache is rightly diagnosed as having a sinus
venous thrombosis or a patient is not being told to have a healthy heart
on the basis of a false negative thallium scan despite having triple
vessel disease. The future medical curriculum will tell.
Scott I .Errors in clinical reasoning:causes and remedial
strategies.BMJ 2009;339 22-25
Rapid Response:
Teaching Clinical Reasoning at Medical School is unavoidable
I really do appreciate the article” Errors in clinical reasoning” by
Ian Scott , but I wonder, why it appeared so late. Clinical reasoning and
decision making is around for some time. The former NEJM editor Jerome
Kassirer published a series of case reports to try to make physician aware
of possible pitfalls of diagnosis and the continuous flow of the
diagnostic process and differential diagnosis over time.
Medical up-to-date and evidence - based -knowledge is very important for a
clinical diagnosis ,but the doctors personal features as mentioned in the
article and continuous self-reflection combined with self-criticism, Gut
feelings and patient centered attitude is paramount for good medical
practice. Karl Popper, a philosopher of science, says:
(1) The game of science is, in principle, without end. . . . .(2) Once a hypothesis has been proposed and tested, and has proved
its mettle, it may not be allowed to drop out without "good reason". A
"good reason" may be, for instance: replacement of the hypothesis by
another which is better testable; or the falsification of one of the
consequences of the hypothesis
Unfortunately medical schools teach contents rather than a structural
reflective approach to a diagnosis, despite Clinical reasoning being so
essential to the medical decision making process.
One would hope,that medical faculties will put more emphasis on clinical
reasoning within the curriculum and improve the treatment decision of
future doctors, so that a pregnant patient with a history of migraine
presenting with acute headache is rightly diagnosed as having a sinus
venous thrombosis or a patient is not being told to have a healthy heart
on the basis of a false negative thallium scan despite having triple
vessel disease. The future medical curriculum will tell.
Scott I .Errors in clinical reasoning:causes and remedial
strategies.BMJ 2009;339 22-25
Kassirer,J.P.,Kopelman R.I. Learning Clinical Reasoning. Lippincott
Williams & Wilkins 1992
Gigerenzer G.,Gut Fellings -Short Cuts to Better Decision Making. Penguin
Books 2007
Klemenz B.,McSherry D.Obtaining medical information from the
internet. J R Coll Physicians Lond. 1997 Jul-Aug;31(4):410-3.
Popper K., The Logic of Scientific Discovery, New York: Harper &
Row, 1968, pp. 53-54
Competing interests:
None declared
Competing interests: No competing interests