Learning clinical reasoning:
Gespeichert in:
| Hauptverfasser: | , , |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Wolters Kluwer Health, Lippincott Williams & Wilkins
2010
|
| Ausgabe: | 2. ed. |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIX, 329 S. Ill., graph. Darst. |
| ISBN: | 078179515X 9780781795159 |
Internformat
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Datensatz im Suchindex
| _version_ | 1804141215534284800 |
|---|---|
| adam_text | Titel: Learning clinical reasoning
Autor: Kassirer, Jerome P.
Jahr: 2010
CONTENTS
Foreword by Faith I Fitzgerald, M.D., MAC.P. and Harold C Sox, Jr., M.D., MACE vii
Preface to the Second Edition ix
Acknowledgments xiii
A Note About the Book s Format xiv
The Processes of Clinical Reasoning
1. Overview....................................
Introduction 3
Diagnosis is an Inferential Process 5
Problem-Solving Strategies 5
Diagnosis Based on Hypothesis Generation and Testing
Alternate Concepts of Diagnostic Strategies 6
Therapeutic Principles 6
Linking Diagnosis and Treatment 7
2. Diagnostic Hypothesis Generation...................................8
Hypotheses and Cues 8
The Cognitive Basis of Hypothesis Generation 8
Hypotheses as a Context 9
Expertise and Error 9
3. Refinement of Diagnostic Hypotheses................................11
Where Refinement Begins and Ends 11
Context and Diagnostic Classification 11
Hypothesis Evolution 12
Sequence of Data Collection 12
Reducing Diagnostic Uncertainty 13
The Differential Diagnosis 14
Relation to Formal Probabilistic Approach 14
4. Use and Interpretation of Diagnostic Tests...........................15
The Function of Tests 15
Quantifying Testing Decisions 15
Sensitivity and Specificity 16
Bayes Rule 17
Testing Principles 18
XV
xvi CONTENTS
Bayesian Revision for Multiple Results 19
Bayesian Revision for Multiple Diseases With Multiple Attributes 21
Pragmatic Considerations in the Probabilistic Approach 22
Interpreting Results 25
When to Test 23
The Threshold Concept 24
The Therapeutic Threshold 24
Testing Thresholds 25
5. Causal Reasoning..................................................28
Definition 28
Using a Causal Model 29
Where in the Diagnostic Process Does Causal Reasoning Fit? 29
Explaining Relations Between Variables 30
6. Diagnostic Verification..............................................31
Definition 31
Criteria of Validity 31
Premature Closure 31
The Penultimate Result: A Working Diagnosis 32
7. Therapeutic Decision Making.......................................33
Principles 33
Treatment Under Conditions of Uncertainty 33
When the Value of Therapeutic Choices is Close 34
Incommensurate Options 34
Quantitative Therapeutic Decision Making 34
8. Examining Evidence................................................36
Introduction 56
Evidence-Based Medicine 36
Asking Questions 36
Searching for Evidence 37
Summarizing and Appraising Evidence 37
Applying the Evidence 37
Practice Guidelines 38
9. Cognitive Errors...................................___.............39
Scope 39
Classification 39
Some Errors may have a Psychological Origin 39
The Nature of Cognitive Errors 39
Cognitive Biases in the Laboratory 40
Consequences of Cognitive Biases 40
Strategies for Avoiding Cognitive Errors 41
10. Some Cognitive Concepts...........................................42
Cognitive Science 42
Studying Mental Processes 42
The Structure of Memory 42
CONTENTS xvii
Search Strategies 44
Characteristics of Expertise 46
11. Learning Clinical Problem Solving...................................48
Facts Versus Process 48
Pedagogic Principles 49
A Specific Example 49
The Goal Should Determine the Format 50
Learning by Instantiation 50
Learning Clinical Problem Solving Versus Problem-Based Learning 51
Cognition at the Bedside; A Set of Examples____________
12. Introduction to the Cases............................................ 55
13. Diagnosfic Hypothesis Generafion..................................56
Case 1. Generation of Diagnostic Hypotheses 56
Case 2. Hypothesis Triggering by an Expert 60
Case 3. A Diagnostic Coup 63
Case 4. A Quick and Accurate Solution 66
Case 5. Better Late Than Never 69
Case 6. A Hit After a Miss 73
Case 7. The Critical Role of Context in the Diagnostic Process 76
Case 8. A Masked Marauder 81
Case 9. A Serious Lack of Focus 84
14. Refinement of Diagnostic Hypotheses................................89
Case 10. What is a Differential Diagnosis? 89
Case 11. An Orderly, Sequential Approach 94
Case 12. Weak Reasoning: Diagnosis by Drug Reaction 96
Case 13. Narrowing Down the Diagnostic Options 100
Case 14. A Picture is Worth a Thousand Words 104
Case 15. Strategies of Information Gathering 108
Case 16. A Fatal Flaw in Sutton s Law 113
Case 17. How to Disregard Red Herrings 118
Case 18. Discrimination: The Problem of Look-Alikes 121
Case 19. Location, Location, Location 125
15. Use and Interpretation of Diagnostic Tests..........................128
Case 20. Interpreting a Negative Test Result 128
Case 21. Diagnosis and the Risks of the Primrose Path 131
Case 22. Searching for a Pony 134
Case 23. Interpreting Hoofbeats: Can Bayes Help Clear the Haze? 137
Case 24. Short-Circuiting the Diagnostic Process 143
Case 25. The Bypass on the Way to the Bypass 145
Case 26. It is What You Believe That Counts 148
Case 27. Renal Rescue by Reverend Bayes 152
Case 28. A Diagnostic Fluke 155
Case 29. Surprise! 157
xviii CONTENTS
Case 30. Tripping Over Technology 161
Case 31. The Probability of a Probability 165
16. Causal Reasoning.................................................169
Case 32. Judging Causality 169
Case 33. Post Hoc, Ergo Propter Hoc 171
Case 34. The Case for Causal Reasoning 175
Case 35. The Tricky Task of Attributing Causation 180
Case 36. The Right Answer for the Wrong Reason 183
17. Diagnostic Verification.............................................186
Case 37. A Point-By-Point Dissection of Clinical Reasoning 186
Case 38. Leaving No Stone Unturned 188
Case 39. Verification 192
Case 40. A Meticulous Approach 196
Case 41. A Diagnostic Quandary 199
Case 42. Diagnosis by Fiat 203
Case 43. Iron Pyrite and Diagnostic Confirmation 207
18. Therapeutic Decision Making......................................209
Case 44. The Surgeon Opts to Operate: Why? 209
Case 45. Treat or Keep Testing? 211
Case 46. Watch and Wait, or Operate? 216
Case 47. An Apple or an Orange? 218
19. Examining Evidence...............................................223
Case 48. A Difficult Tradeoff 223
Case 49. Making Judgments When the Evidence is Not Definitive 225
Case 50. Using and Citing Published Evidence 227
Case 51. A Little Math Makes the Medicine Go Down 229
Case 52. A Rewarding Pursuit of Certainty 234
Case 53. Treating Before Knowing 239
20. Cognitive Errors...................................................244
Case 54. A Defective Detective 244
Case 55. Remedies for Faulty Hypothesis Generation 248
Case 56. A Disaster Averted 252
Case 57. Derailed by the Availability Heuristic 255
Case 58. Wrong Diagnosis, Wrong Tests, Wrong Treatment 262
Case 59. Reconsidering Failures of Therapy 266
Case 60. The Cheetah and the Snail 267
Case 61. A Collection of Cognitive Diagnostic Errors 271
21. Some Cognitive Concepts..........................................275
Case 62. A Message about Methods 275
Case 63. Memory; How We Overcome its Limitations 279
Case 64. Diagnosis and the Structure of Memory; Disease Polymorphism and
Mental Models 281
Case 65. Intuitive and Inspirational, or Inductive and Incremental? 286
Case 66. Knowledge and Clinical Expertise 291
CONTENTS xix
22. Learning Clinical Problem Solving..................................295
Case 67. Learning Clinical Reasoning from Examples 295
Case 68. Making a Silk Purse out of a Sow s Ear 299
Case 69. Optimizing Case Discussions 304
Glossary 308
Bibliography 313
Index 325
|
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| spelling | Kassirer, Jerome P. Verfasser aut Learning clinical reasoning Jerome P. Kassirer ; John B. Wong ; Richard I. Kopelman 2. ed. Philadelphia [u.a.] Wolters Kluwer Health, Lippincott Williams & Wilkins 2010 XIX, 329 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Diagnosis Decision Making Clinical Medicine Clinical medicine - Decision making Medical logic Medical logic - Case studies Klinische Medizin (DE-588)4134748-1 gnd rswk-swf Therapieplan (DE-588)4121771-8 gnd rswk-swf Case Reports Klinische Medizin (DE-588)4134748-1 s Therapieplan (DE-588)4121771-8 s DE-604 Wong, John B. Verfasser aut Kopelman, Richard I. Verfasser aut HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=019002900&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Kassirer, Jerome P. Wong, John B. Kopelman, Richard I. Learning clinical reasoning Diagnosis Decision Making Clinical Medicine Clinical medicine - Decision making Medical logic Medical logic - Case studies Klinische Medizin (DE-588)4134748-1 gnd Therapieplan (DE-588)4121771-8 gnd |
| subject_GND | (DE-588)4134748-1 (DE-588)4121771-8 |
| title | Learning clinical reasoning |
| title_auth | Learning clinical reasoning |
| title_exact_search | Learning clinical reasoning |
| title_full | Learning clinical reasoning Jerome P. Kassirer ; John B. Wong ; Richard I. Kopelman |
| title_fullStr | Learning clinical reasoning Jerome P. Kassirer ; John B. Wong ; Richard I. Kopelman |
| title_full_unstemmed | Learning clinical reasoning Jerome P. Kassirer ; John B. Wong ; Richard I. Kopelman |
| title_short | Learning clinical reasoning |
| title_sort | learning clinical reasoning |
| topic | Diagnosis Decision Making Clinical Medicine Clinical medicine - Decision making Medical logic Medical logic - Case studies Klinische Medizin (DE-588)4134748-1 gnd Therapieplan (DE-588)4121771-8 gnd |
| topic_facet | Diagnosis Decision Making Clinical Medicine Clinical medicine - Decision making Medical logic Medical logic - Case studies Klinische Medizin Therapieplan Case Reports |
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