The challenge of clinical reasoning in chronic multimorbidity: time and interactions in the Health Issues Network model
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Fabrizio Consorti
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Dario Torre
Abstract
The increasing prevalence of multimorbidity requires new theoretical models and educational approaches to develop physicians’ ability to manage multimorbidity patients. The Health Issues Network (HIN) is an educational approach based on a graphical depiction of the evolutions over time of the concurrent health issues of a patient and of their interactions. From a theoretical point of view, the HIN approach is rooted in Prigogine’s vision of the “becoming” of the events and in the concept of knowledge organization, intended as the process of storing and structuring of information in a learner’s mind. The HIN approach allows to design clinical exercises to foster learners’ ability to detect evolutionary paths and interactions among health issues. Recent findings of neuroscience support the expectation that interpreting, completing, and creating diagrams depicting complex clinical cases improves the “sense of time”, as a fundamental competence in the management of multimorbidity. The application of the HIN approach is expected to decrease the risk of errors in the management of multimorbidity patients. The approach is still under validation, both for undergraduate students and for the continuous professional development of physicians.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interest: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: Not applicable.
References
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Articles in the same Issue
- Frontmatter
- Reviews
- Diagnostic errors in uncommon conditions: a systematic review of case reports of diagnostic errors
- Routine blood test markers for predicting liver disease post HBV infection: precision pathology and pattern recognition
- Opinion Papers
- The challenge of clinical reasoning in chronic multimorbidity: time and interactions in the Health Issues Network model
- The first diagnostic excellence conference in Japan
- Clouds across the new dawn for clinical, diagnostic and biological data: accelerating the development, delivery and uptake of personalized medicine
- Original Articles
- Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process
- Error codes at autopsy to study potential biases in diagnostic error
- Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data
- Detection of fake papers in the era of artificial intelligence
- Is language an issue? Accuracy of the German computerized diagnostic decision support system ISABEL and cross-validation with the English counterpart
- The feasibility of a mystery case curriculum to enhance diagnostic reasoning skills among medical students: a process evaluation
- Internal medicine intern performance on the gastrointestinal physical exam
- Scaling up a diagnostic pause at the ICU-to-ward transition: an exploration of barriers and facilitators to implementation of the ICU-PAUSE handoff tool
- Learned cautions regarding antibody testing in mast cell activation syndrome
- Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care
- Incomplete filling of spray-dried K2EDTA evacuated blood tubes: impact on measuring routine hematological parameters on Sysmex XN-10
- Letters to the Editor
- The diagnostic accuracy of AI-based predatory journal detectors: an analogy to diagnosis
- Explainable AI for gut microbiome-based diagnostics: colorectal cancer as a case study
- Restless X syndrome: a new diagnostic family of nocturnal, restless, abnormal sensations of various body parts
- Erratum
- Retraction of: Establishing a stable platform for the measurement of blood endotoxin levels in the dialysis population
