The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine
#90: Clinical Reasoning: Become an expert diagnostician
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Become an expert diagnostician like Dr Gurpreet Dhaliwal, Professor of Medicine at UCSF. Join us for this deep dive into clinical reasoning and how doctors think! Topics include: how to improve your own clinical reasoning and diagnostic skills, how to teach these skills, and the initial steps to building your own expertise/mastery in clinical medicine! Dr. Osler once admonished his students to build experiential wisdom and follow-up with their clinical cases (clear cases, doubtful cases, and mistakes), but to do so, one must “...learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch.” Test yo’ self: Take our quiz here
Written and produced by: Stuart Brigham, MD; Images by Hannah Abrams; Edited by: Matthew Watto, MD
Full show notes available at http://thecurbsiders.com/podcast
Goal: Listeners will gain an appreciation for the Clinical Reasoning process and the difficulties that underpin building expertise in medicine.
After listening to this episode listeners will…
- Develop an appreciation for clinical reasoning.
- Recall the importance that the educator plays in role modeling.
- Learn how to improve diagnostic accuracy by keeping a patient log.
- Identify the common nomenclature used in clinical reasoning and how teaching this common verbiage could serve to improve diagnostic accuracy
- Recognize that misdiagnosis is common in clinical practice and every clinician could benefit from deliberate practice.
- Explain the difference between experience and expertise.
- 00:00 Disclaimer, Intro
- 02:30 Guest Bio
- 04:50 Dr. Dhaliwal
- 06:45 Book recommendation
- 09:14 App recommendation
- 11:34 Advice for learners and teachers (Pearl #1)
- 12:40 Can a computer out-think a human?
- 15:49 Defining Clinical Reasoning
- 18:38 “Train the Brain” introduced
- 20:30 Knowledge is a precondition
- 21:46 A learner who lacks synthesis
- 24:23 How to provide learner feedback
- 27:04 Defining problem representation, illness scripts, etc.
- 29:20 How to start teaching clinical reasoning
- 31:00 Focus on the “why” and not the “what”
- 32:11 Teaching the nomenclature of clinical reasoning
- 36:07 “You can’t get the right answer if the brain is solving the wrong problem”
- 36:34 Osler and his “Incessant Watch”
- 40:40 Being wrong feels exactly the same as being right
- 42:00 Patient tracking (Dr. Dhaliwal’s recommendation)
- 45:30 Why keeping a patient log is so important
- 47:00 Are heuristics beneficial?
- 48:55 Can you debias yourself?
- 50:00 “Going slow just makes you slow.”
- 52:00 All evidence has flaws, but knowledge is still king.
- 55:13 Clinical reasoning on multi-disciplinary teams
- 59:27 Take-home points
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