The 6C model for accurately capturing the patient’s medical history
-
Taro Shimizu
Abstract
Diagnostic errors are an internationally recognized patient safety concern, and leading causes are faulty data gathering and faulty information processing. Obtaining a full and accurate history from the patient is the foundation for timely and accurate diagnosis. A key concept underlying ideal history acquisition is “history clarification,” meaning that the history is clarified to be depicted as clearly as a video, with the chronology being accurately reproduced. A novel approach is presented to improve history-taking, involving six dimensions: Courtesy, Control, Compassion, Curiosity, Clear mind, and Concentration, the ‘6 C’s’. I report a case that illustrates how the 6C approach can improve diagnosis, especially in relation to artificial intelligence tools that assist with differential diagnosis.
-
Research funding: None declared.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Ethical approval: Not applicable.
References
1. Schwartz, WB. Medicine and the computer-the promise and problems of change. N Engl J Med 1970;283:1257–64. https://doi.org/10.1056/nejm197012032832305.Search in Google Scholar PubMed
2. Semigran, HL, Linder, JA, Gidengil, C, Mehrotra, A. Evaluation of symptom checkers for self diagnosis and triage: audit study. BMJ 2015;351:h3480. https://doi.org/10.1136/bmj.h3480.Search in Google Scholar PubMed PubMed Central
3. Semigran, HL, Levine, DM, Nundy, S, Mehrotra, A. Comparison of physician and computer diagnostic accuracy. JAMA Intern Med 2016;176:1860–1. https://doi.org/10.1001/jamainternmed.2016.6001.Search in Google Scholar PubMed
4. Harada, T, Shimizu, T, Kaji, Y, Suyama, Y, Matsumoto, T, Kosaka, S, et al.. A perspective from a case conference on comparing the diagnostic process: human diagnostic thinking vs. AI decision support tools. Int J Environ Res Publ Health 2020;17:6110. https://doi.org/10.3390/ijerph17176110.Search in Google Scholar PubMed PubMed Central
5. Institute of Medicine. National academies of sciences, engineering, and medicine. To err is human. Washington, DC: National Academies Press; 2001.Search in Google Scholar
6. Graber, ML. The incidence of diagnostic error in medicine. BMJ Qual Saf 2013;22(2 suppl):ii21–7. https://doi.org/10.1136/bmjqs-2012-001615.Search in Google Scholar PubMed PubMed Central
7. The National Academies of Science Engineering and Medicine. Improving diagnosis in health care. Washington, DC: The National Academies Press; 2015.Search in Google Scholar
8. ECRI. Top 10 patient safety concerns 2020; 2020. Available from: https://www.ecri.org/landing-top-10-patient-safety-concerns-2020.Search in Google Scholar
9. Friedman, CP. A “fundamental theorem” of biomedical informatics. J Am Med Inf Assoc 2009;16:169–70. https://doi.org/10.1197/jamia.m3092.Search in Google Scholar
10. Rajkomar, A, Dean, J, Kohane, I. Machine learning in medicine. N Engl J Med 2019;380:1347–58. https://doi.org/10.1056/nejmra1814259.Search in Google Scholar PubMed
11. Croskerry, P. A universal model of diagnostic reasoning. Acad Med 2009;84:1022–8. https://doi.org/10.1097/acm.0b013e3181ace703.Search in Google Scholar PubMed
12. Shimizu, T, Tokuda, Y. Pivot and cluster strategy: a preventive measure against diagnostic errors. Int J Gen Med 2012;5:917–21. https://doi.org/10.2147/ijgm.s38805.Search in Google Scholar PubMed PubMed Central
13. Shimizu, T. Horizontal and vertical tracing: a cognitive forcing strategy to improve diagnostic accuracy. Postgrad Med J 2020;96:581–83. https://doi.org/10.1136/postgradmedj-2020-137548.Search in Google Scholar PubMed
14. Heneghan, C, Glasziou, P, Thompson, M, Rose, P, Balla, J, Lasserson, D, et al.. Diagnostic strategies used in primary care. BMJ 2009;338:b946. https://doi.org/10.1136/bmj.b946.Search in Google Scholar PubMed PubMed Central
15. Chang, R, Bordage, G, Connell, K. The importance of early problem representation during case presentations. Acad Emerg Med 1998;73:S109–11. https://doi.org/10.1097/00001888-199810000-00062.Search in Google Scholar PubMed
16. Graber, ML, Franklin, N, Gordon, R. Diagnostic error in internal medicine. Arch Intern Med 2005;165:1493–9. https://doi.org/10.1001/archinte.165.13.1493.Search in Google Scholar PubMed
17. Jutel, AG. Putting a name to it: diagnosis in contemporary society. New York, NY: JHU Press; 2011.10.1353/book.1850Search in Google Scholar
18. Merkebu, J, Battistone, M, McMains, K, McOwen, K, Witkop, C, Konopasky, A, et al.. Situativity: a family of social cognitive theories for understanding clinical reasoning and diagnostic error. Diagnosis(Berl) 2020;7:169–76. https://doi.org/10.1515/dx-2019-0100.Search in Google Scholar PubMed
19. Bergeson, SC, Dean, JD. A systems approach to patient-centered care. JAMA 2006;296:2848–51. https://doi.org/10.1001/jama.296.23.2848.Search in Google Scholar PubMed
20. Stewart, M, Brown, JB, Donner, A, McWhinney, IR, Oates, J, Weston, WW, et al.. The impact of patient-centered care on outcomes. J Fam Pract 2000;49:796–804.Search in Google Scholar
21. Fustino, NJ, Wohlfeil, M, Smith, HL. Determination of key drivers of patient experience in a midsize pediatric hematology-oncology ambulatory clinic. Ochsner J Winter 2018;18:332–8. https://doi.org/10.31486/toj.18.0091.Search in Google Scholar PubMed PubMed Central
22. Bendesky, BS, Hunter, K, Kirchhoff, MA, Jones, CW. Same physician, different location, different patient satisfaction scores. Ann Emerg Med 2016;68:531–5. https://doi.org/10.1016/j.annemergmed.2015.12.021.Search in Google Scholar PubMed
23. Hooper, EM, Comstock, LM, Goodwin, JM, Goodwin, JS. Patient characteristics that influence physician behavior. Med Care 1982;20:630–8. https://doi.org/10.1097/00005650-198206000-00009.Search in Google Scholar PubMed
24. Angermeyer, MC, Schulze, B, Dietrich, S. Courtesy stigma--a focus group study of relatives of schizophrenia patients. Soc Psychiatr Psychiatr Epidemiol 2003;38:593–602. https://doi.org/10.1007/s00127-003-0680-x.Search in Google Scholar PubMed
25. Grover, S, Aneja, J, Hazari, N, Chakrabarti, S, Avasthi, A. Stigma and its correlates among caregivers of patients with bipolar disorder. Indian J Psychol Med 2019;41:455–61. https://doi.org/10.4103/ijpsym.ijpsym_24_19.Search in Google Scholar
26. Kirmayer, LJ, Groleau, D, Looper, KJ, Dao, MD. Explaining medically unexplained symptoms. Can J Psychiatr 2004;49:663–72. https://doi.org/10.1177/070674370404901003.Search in Google Scholar PubMed
27. Donner-Banzhoff, N, Hertwig, R. Inductive foraging: improving the diagnostic yield of primary care consultations. Eur J Gen Pract 2014;20:69–73. https://doi.org/10.3109/13814788.2013.805197.Search in Google Scholar PubMed
28. Donner-Banzhoff, N. Solving the diagnostic challenge: a patient-centered approach. Ann Fam Med 2018;16:353–8. https://doi.org/10.1370/afm.2264.Search in Google Scholar PubMed PubMed Central
29. Donner-Banzhoff, N, Seidel, J, Sikeler, AM, Bösner, S, Vogelmeier, M, Westram, A, et al.. The phenomenology of the diagnostic process: a primary care-based survey. Med Decis Making 2017;37:27–34. https://doi.org/10.1177/0272989x16653401.Search in Google Scholar PubMed
30. Bösner, S, Abushi, J, Feufel, M, Donner-Banzhoff, N. Diagnostic strategies in general practice and the emergency department: a comparative qualitative analysis. BMJ Open 2019;9:e026222. https://doi.org/10.1136/bmjopen-2018-026222.Search in Google Scholar PubMed PubMed Central
31. Frankel, RM. Relationship-centered care and the patient-physician relationship. J Gen Intern Med 2004;19:1163–5. https://doi.org/10.1111/j.1525-1497.2004.40901.x.Search in Google Scholar PubMed PubMed Central
32. Aramesh, K. Compassion as the reunion of feminine and masculine virtues in medicine. J Med Ethics Hist Med 2017;10:8.Search in Google Scholar
33. Neighbour, R. The inner consultation, 2nd ed. New York, NY: Taylor & Francis Ltd; 2015.Search in Google Scholar
34. Werner, A, Rieber, N, Zipfel, S. Curiosity’s curious influence on medical doctors. Med Educ 2011;45:656–8. https://doi.org/10.1111/j.1365-2923.2011.04030.x.Search in Google Scholar PubMed
35. Osler, W. Aequanimitas: with other addresses to medical students, nurses and practitioners of medicine. New York, NY: Ulan Press; 2012.Search in Google Scholar
36. Saultz, JW. Textbook of family medicine. New York, NY: McGraw Hill; 1999.Search in Google Scholar
37. Rhoades, DR, McFarland, KF, Finch, WH, Johnson, AO. Speaking and interruptions during primary care office visits. Fam Med 2001;33:528–32.Search in Google Scholar
38. Cannarella Lorenzetti, R, Jacques, CH, Donovan, C, Cottrell, S, Buck, J. Managing difficult encounters: understanding physician, patient, and situational factors. Am Fam Physician 2013;87:419–25.Search in Google Scholar
39. Krasner, MS, Epstein, RM, Beckman, H, Suchman, AL, Chapman, B, Mooney, CJ, et al.. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 2009;302:1284–93. https://doi.org/10.1001/jama.2009.1384.Search in Google Scholar PubMed
© 2021 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- From Camille Nούς to Apollonian and the Dionysian scientists
- Review
- The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
- Mini Reviews
- Updated picture of SARS-CoV-2 variants and mutations
- Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury
- Opinion Papers
- The 6C model for accurately capturing the patient’s medical history
- Webside manner: maskless communication
- Original Articles
- Ways that nurse practitioner students self-explain during diagnostic reasoning
- Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain
- Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors
- Use of a structured approach and virtual simulation practice to improve diagnostic reasoning
- Analyzing diagnostic errors in the acute setting: a process-driven approach
- Morning report goes virtual: learner experiences in a virtual, case-based diagnostic reasoning conference
- Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods
- Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality
- Automated capture-based NGS workflow: one thousand patients experience in a clinical routine framework
- Short Communication
- Characterizing the relationship between diagnostic intensity and quality of care
- Case Reports – Lessons in Clinical Reasoning
- Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and “picking at the air”
- Hickam’s dictum, Occam’s razor, and Crabtree’s bludgeon: a case of renal failure and a clavicular mass
- Letters to the Editor
- Three learning concepts to improve diagnosis and enhance the practice of medicine
- Distributed cognition: a framework for conceptualizing telediagnosis in teams
- Performance of Fujirebio Espline SARS-CoV-2 rapid antigen test for identifying potentially infectious individuals
Articles in the same Issue
- Frontmatter
- Editorial
- From Camille Nούς to Apollonian and the Dionysian scientists
- Review
- The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis
- Mini Reviews
- Updated picture of SARS-CoV-2 variants and mutations
- Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury
- Opinion Papers
- The 6C model for accurately capturing the patient’s medical history
- Webside manner: maskless communication
- Original Articles
- Ways that nurse practitioner students self-explain during diagnostic reasoning
- Diagnostic reasoning: relationships among expertise, accuracy, and ways that nurse practitioner students self-explain
- Perspectives on the current state of pre-clerkship clinical reasoning instruction in United States medical schools: a survey of clinical skills course directors
- Use of a structured approach and virtual simulation practice to improve diagnostic reasoning
- Analyzing diagnostic errors in the acute setting: a process-driven approach
- Morning report goes virtual: learner experiences in a virtual, case-based diagnostic reasoning conference
- Stroke hospitalization after misdiagnosis of “benign dizziness” is lower in specialty care than general practice: a population-based cohort analysis of missed stroke using SPADE methods
- Discrepancy between emergency department admission diagnosis and hospital discharge diagnosis and its impact on length of stay, up-triage to the intensive care unit, and mortality
- Automated capture-based NGS workflow: one thousand patients experience in a clinical routine framework
- Short Communication
- Characterizing the relationship between diagnostic intensity and quality of care
- Case Reports – Lessons in Clinical Reasoning
- Lessons in clinical reasoning ‒ pitfalls, myths, and pearls: a case of confusion, disequilibrium, and “picking at the air”
- Hickam’s dictum, Occam’s razor, and Crabtree’s bludgeon: a case of renal failure and a clavicular mass
- Letters to the Editor
- Three learning concepts to improve diagnosis and enhance the practice of medicine
- Distributed cognition: a framework for conceptualizing telediagnosis in teams
- Performance of Fujirebio Espline SARS-CoV-2 rapid antigen test for identifying potentially infectious individuals
