Diagnostic Decision-Making
Rationale
Physicians are responsible for directing and conducting the diagnostic evaluation of a broad range of patients, including acutely and chronically ill patients. In a time of rapidly proliferating tests, internists must design safe, expeditious, and cost-effective diagnostic evaluations. This requires well-developed diagnostic decision-making skills that incorporate probability-based thinking.
Prerequisite
Courses in clinical epidemiology and physical diagnosis.
Specific Learning Objectives
- Knowledge: Each student should be able to describe:
- key history and physical examination findings pertinent to the differential diagnosis.
- information resources for determining diagnostic options for patients with common and uncommon medical problems.
- key factors to consider when selecting from among diagnostic tests, including pretest probabilities, performance characteristics of tests (sensitivity, specificity, likelihood ratios), cost, risk, and patient preferences.
- the relative cost of diagnostic tests.
- how critical pathways or practice guidelines can be used to guide diagnostic test ordering.
- the method of deductive reasoning.
- Skills: Each student should be able to:
- formulate a differential diagnosis based on the findings from the history and physical examination.
- use probability-based thinking to identify the most likely diagnoses.
- use the differential diagnosis to help guide diagnostic test ordering and sequence.
- use pretest probabilities and scientific evidence about performance characteristics of tests (sensitivity, specificity, likelihood ratios) to determine post-test probabilities according to the predictive value paradigm.
- participate in selecting the diagnostic studies with the greatest likelihood of providing useful results at a reasonable cost.
- Attitudes: Each student should:
- incorporate the patient’s perspective into diagnostic decision-making.
- limit the chances of false positive/false negative results by demonstrating thoughtful test selection.