Exploring synthesis as a vital cognitive skill in complex clinical diagnosis
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Dilushi Wijayaratne
,
Praveen Weeratunga
und
Saroj Jayasinghe
Abstract
Clinicians employ two main cognitive approaches for diagnoses, depending on their expertise. Novices typically use linear hypothetico-deductive methods, while experts rely more on intuitive pattern recognition. These closely correspond to System 1 and System 2 thinking described in behavioral economics. We propose that complex cases additionally require the cognitive skill of synthesis, to visualize and understand the connections between various elements. To illustrate the concept, we describe a 60-year-old individual with a 6 h history of chest pain, fever, cough, accompanying chronic heart failure, atrial fibrillation, COPD, thyrotoxicosis, and ischemic heart disease. Faced with such a scenario, a bedside approach adapted by clinicians is to generate a list of individual diagnoses or pathways of pathogenesis, and address them individually. For example, this cluster could include: smoking causing COPD, IHD leading to chest pain and heart failure, and thyrotoxicosis causing atrial fibrillation (AF). However, other interconnections across pathways could be considered: smoking contributing to IHD; COPD exacerbating heart failure; IHD and pneumonia triggering atrial fibrillation; thyrotoxicosis and AF, independently worsening heart failure; COPD causing hypoxemia and worsening ventricular function. The second cluster of explanation offers a richer network of relationships and connections across disorders and pathways of pathogenesis. This cognitive process of creatively identifying these relationships is synthesis, described in Bloom’s taxonomy of the cognitive domain. It is a crucial skill required for visualizing a comprehensive and holistic view of a patient. The concept of synthesis as a cognitive skill in clinical reasoning warrants further exploration.
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Research ethics: Not applicable.
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Informed consent: Not applicable.
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Author contributions: The initial concept was drafted by SJ and DW and PW contributed to developing it further with examples and in drafting the final manuscript. All authors read approved the final version of the manuscript.
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Competing interests: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: Not applicable.
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© 2024 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Opinion Paper
- Exploring synthesis as a vital cognitive skill in complex clinical diagnosis
- Original Articles
- Physiologic measurements of cognitive load in clinical reasoning
- Impact of diagnostic management team on patient time to diagnosis and percent of accurate and clinically actionable diagnoses
- Game-based learning to improve diagnostic accuracy: a pilot randomized-controlled trial
- A patient follow-up intervention to improve medical decision making at an internal medicine residency program
- Application of a diagnosis flow draft based on appearance impression for detection of vulvar disease
- The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation
- Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area
- Use of saliva-based qPCR diagnostics for the accurate, rapid, and inexpensive detection of strep throat
- Short Communications
- Improving communication of diagnostic uncertainty to families of hospitalized children
- Association of diagnostic error education and recognition frequency among Japanese medical students: a nationwide cross-sectional study
- Updated statistics on Influenza mortality
- Letters to the Editor
- How case reports can be used to improve diagnosis
- Clinical assessment of Ortho VITROS SARS-CoV-2 antigen chemiluminescence immunoassay
- Convicting a wrong molecule?
- Case Reports - Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: a woman brought to a halt
- Lessons in clinical reasoning – pitfalls, myths, and pearls: shoulder pain as the first and only manifestation of lung cancer
- Congress Abstracts
- The Future of Diagnosis: Achieving Excellence and Equity
- The Future of Diagnosis: Navigating Uncertainty
Artikel in diesem Heft
- Frontmatter
- Opinion Paper
- Exploring synthesis as a vital cognitive skill in complex clinical diagnosis
- Original Articles
- Physiologic measurements of cognitive load in clinical reasoning
- Impact of diagnostic management team on patient time to diagnosis and percent of accurate and clinically actionable diagnoses
- Game-based learning to improve diagnostic accuracy: a pilot randomized-controlled trial
- A patient follow-up intervention to improve medical decision making at an internal medicine residency program
- Application of a diagnosis flow draft based on appearance impression for detection of vulvar disease
- The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation
- Troponin testing in routine primary care: observations from a dynamic cohort study in the Amsterdam metropolitan area
- Use of saliva-based qPCR diagnostics for the accurate, rapid, and inexpensive detection of strep throat
- Short Communications
- Improving communication of diagnostic uncertainty to families of hospitalized children
- Association of diagnostic error education and recognition frequency among Japanese medical students: a nationwide cross-sectional study
- Updated statistics on Influenza mortality
- Letters to the Editor
- How case reports can be used to improve diagnosis
- Clinical assessment of Ortho VITROS SARS-CoV-2 antigen chemiluminescence immunoassay
- Convicting a wrong molecule?
- Case Reports - Lessons in Clinical Reasoning
- Lessons in clinical reasoning – pitfalls, myths, and pearls: a woman brought to a halt
- Lessons in clinical reasoning – pitfalls, myths, and pearls: shoulder pain as the first and only manifestation of lung cancer
- Congress Abstracts
- The Future of Diagnosis: Achieving Excellence and Equity
- The Future of Diagnosis: Navigating Uncertainty
