David,
There are studies (which I can't put my hands on) that suggest that in
areas where one is expert/practiced diagnoses are made based on pattern
recognition (or probably better, decision-making algorithms which are so
practiced that they are largely inaccessible to conscious reflection).
In less familiar terrain, diagnosticians are prone to rely on more
explicit (and usually linear) decision-making strategies.
And then there is just jumping to conclusions!
Regards.
> ----------
> From: David Gill[SMTP:[log in to unmask]]
> Reply To: David Gill
> Sent: Thursday, February 05, 1998 4:22 AM
> To: [log in to unmask]; [log in to unmask]
> Subject: "Reverse Diagnosis"
>
> Dear lists
>
> Clinicians don't always (/often?) proceed from symptoms to
> examination to diagnosis to treatment in a linear fashion.
>
> Consider depression in general practice. If the GP only has
> tricyclics as his available treatment option, he may refrain from
> making the diagnosis at all if he believes that the patient will not
> tolerate their adverse effects ( e.g.a patient with cardiac
> problems).
>
> The advent of SSRIs has expanded the available treatment options, and
> diagnoses of depression ( or at any rate, prescriptions of
> antidepressants ) have risen. It seems that GPs may identify patients
> as a "case of Prozac", and
> then move from the possible treatment back to eliciting the
> diagnosis.
>
> Has anyone any references to this "non-linear" diagnostic process?
>
> NB this is not meant as an adverse criticism of GPs.
>
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