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Robyn Brady: Diagnostic reasoning at DFTB17


This talk was recorded live on the second day at DFTB17 in Brisbane.

When you start in any branch of medicine, there are so many unknowns that it makes sense to follow the well-trodden path of those who have gone before you. Using checklists and flowcharts makes sense to ensure you are not missing something. It makes sense to look at resources like DFTB. But then what? Not all patients fit into neat little boxes, presenting with classical signs and symptoms. Then what do you do? Paediatrician Robyn Brady explores how we can learn to think beyond the algorithm.

As medical professionals, our daily practice revolves around the intricate art of diagnostic reasoning. It is an essential skill that shapes our approach to patient care and treatment decisions.

Mind Mapping: Unlocking Cognitive Potential

Mind mapping allows us to organize complex information, identify patterns, and make connections. Aligning with dual-process theory, mind mapping recognizes the interplay between logical, analytical thinking and intuitive, creative thinking.

Incorporating mind maps into our practice can help us overcome cognitive biases and broaden our diagnostic perspectives. Whether it’s during a resuscitation or a case discussion, mind mapping can facilitate collaborative problem-solving and promote a deeper understanding of patient presentations.

Best Problem Formulation: The Core of Diagnostic Reasoning

Dr. Brady highlights the importance of continuously evolving our “best problem formulation” (BPF). This term refers to the central concept that guides our diagnostic approach. BPF sets the stage for our differential diagnoses, investigations, and treatment plans. It’s crucial that everyone involved in a case shares the same BPF to ensure effective communication and coordinated care.

Effective problem formulation involves avoiding the cognitive error of “framing,” where our initial impressions bias our diagnostic thinking. Instead, we should aim to maintain a flexible, open-minded approach that adapts as new information emerges during a patient encounter.

Intuitive Reasoning: The Power of Pattern Recognition

Intuitive reasoning, often associated with the right brain, is not merely a mystical gut feeling. It is rooted in the patterns and variations we have observed throughout our medical careers. Intuitive reasoning is parallel processing, allowing us to make rapid decisions based on our accumulated knowledge.

However, intuitive reasoning is highly individualized and influenced by emotions and contextual factors. While it can be a valuable asset, it should be complemented by analytical thinking and collaborative discussions to ensure well-rounded diagnostic assessments.

The Importance of Zooming In and Out

Effective diagnostic reasoning requires us to constantly zoom in and out of the patient’s clinical picture. We must maintain a “big picture” perspective to consider all relevant factors while also zooming in to scrutinize specific details. This approach ensures we don’t overlook critical clues or dismiss important information.

Odds vs. Stakes: Balancing Risk and Urgency

Understanding the concept of odds versus stakes is vital in medical decision-making. Some cases may have high stakes, where immediate action is crucial, even if the odds of a specific diagnosis are low. Balancing these factors is essential to providing timely and appropriate patient care.

Cognitive Stop Points: Recognizing When to Pause

Use cognitive stop points – moments when we should pause and reassess our diagnostic path. These stop points are triggered when objective findings don’t align with our initial hypotheses or when something feels off about a case. Recognizing these moments and investigating further can prevent diagnostic errors.

Diagnostic reasoning is a dynamic and multifaceted process that forms the foundation of our medical practice. By incorporating mind mapping, evolving our best problem formulations, and balancing intuitive and analytical reasoning, we can enhance patient care and ensure better outcomes. Recognizing the importance of cognitive stop points and embodied knowledge further strengthens our diagnostic capabilities. As medical professionals, our commitment to continuous learning and reflection is essential for providing the best possible care to our patients.

You can listen to this talk as you walk to work on any device that supports podcasts.

Robyn is also the director of the Sprung Integrated Dance Theatre, a not-for-profit organisation that provides workshops for persons with disability with the aim to inspire audiences and promote inclusion. Robyn’s daughter, Tara, will be speaking at DFTB18.

Robyn and Tara will also be leading a unique workshop on the Sunday before the conference, encouraging us all to shed our skins, and learn to play. You can find out more about it here.

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