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Open AccessJournal ArticleDOI

Solving the Diagnostic Challenge: A Patient-Centered Approach

Norbert Donner-Banzhoff
- 01 Jul 2018 - 
- Vol. 16, Iss: 4, pp 353-358
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TLDR
New evidence is discussed about how patients and clinicians collaborate in specific ways, in particular, via a process that can be termed inductive foraging, which may lead to information that triggers a diagnostic routine.
Abstract
Arriving at an agreed-on and valid explanation for a clinical problem is important to patients as well as to clinicians. Current theories of how clinicians arrive at diagnoses, such as the threshold approach and the hypothetico-deductive model, do not accurately describe the diagnostic process in general practice. The problem space in general practice is so large and the prior probability of each disease being present is so small that it is not realistic to limit the diagnostic process to testing specific diagnoses on the clinician's list of possibilities. Here, new evidence is discussed about how patients and clinicians collaborate in specific ways, in particular, via a process that can be termed inductive foraging, which may lead to information that triggers a diagnostic routine. Navigating the diagnostic challenge and using patient-centered consulting are not separate tasks but rather synergistic.

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Citations
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Opening the black box of machine learning in radiology: can the proximity of annotated cases be a way?

TL;DR: This work proposes a strategy to open the black box by presenting to the radiologist the annotated cases (ACs) proximal to the current case (CC), making decision rationale and uncertainty more explicit.
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The phenomenology of the diagnostic process: A primary-care based survey

TL;DR: Cognitive strategies used by GPs for making a diagnosis are investigated to suggest that GPs organize their search for information in a skillfully adapted way and the testing of specific disease hypotheses seems to play a lesser role than previously thought.
References
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TL;DR: Decision curve analysis is a suitable method for evaluating alternative diagnostic and prognostic strategies that has advantages over other commonly used measures and techniques.
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Confirmation, Disconfirmation, and Information in Hypothesis Testing

TL;DR: The authors showed that the positive test strategy can be a very good heuristic for determining the truth or falsity of a hypothesis under realistic conditions, but it can also lead to systematic errors or inefficiencies.
Book

Patient-Centered Medicine: Transforming the Clinical Method

TL;DR: In this paper, the authors describe the four components of the patient-centered clinical method: exploring health, disease and the illness experience, understanding the whole person, finding common ground and enhancing the patientclinician relationship.
Journal ArticleDOI

The threshold approach to clinical decision making.

TL;DR: Using the concepts of decision analysis, expressions for two threshold probabilities involved in the choice of whether to withhold treatment, obtain more data by testing, or treat without subjecting the patient to the risks of further diagnostic tests are derived.
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