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Physicians’ prism: illuminating history with structured expertise

  • Taro Shimizu EMAIL logo
Published/Copyright: April 11, 2025
Diagnosis
From the journal Diagnosis Volume 12 Issue 3

Abstract

Enhancing the resolution of patient history is crucial for accurate diagnosis and improving patient outcomes. This paper introduces the “GREAT PRISM” strategy, a framework to eliminate barriers to reconstructing comprehensive patient history. Grounded in Grid analysis, the analysis organizes patient information along temporal and symptomatic axes to achieve high-resolution narratives for reaching an accurate diagnosis. Techniques such as identifying missing information, uncovering hidden histories, and dissecting temporal patterns are explored. While emphasizing cognitive forcing strategies and practical applications, this method bridges the gap between traditional practices and modern diagnostic approaches, fostering precision in diagnostic excellence from the point-of-care perspective.

Keywords: improving diagnosis; diagnostic error; diagnostic excellence; clinical reasoning; medical history
Corresponding author: Taro Shimizu, MD, MSc, MPH, MBA, PhD, FACP, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0297, Japan, E-mail:

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: TS created the draft. The author has accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The author states no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: Not applicable.

References

1. Clark, BW, Derakhshan, A, Desai, SV. Diagnostic errors and the bedside clinical examination. Med Clin North Am 2018;102:453–64. https://doi.org/10.1016/j.mcna.2017.12.007.Search in Google Scholar PubMed

2. Brubacher, SP, Gilligan, C, Burrows, KS, Powell, MB. Information gathering in investigative and medical interviewing: drawing parallels across contexts. Health Commun 2021;36:521–8. https://doi.org/10.1080/10410236.2019.1700884.Search in Google Scholar PubMed

3. Shimizu, T. The 6C model for accurately capturing the patient’s medical history. Diagnosis (Berl) 2022;9:28–33. https://doi.org/10.1515/dx-2020-0126.Search in Google Scholar PubMed

4. Mazer, LM, Storage, T, Bereknyei, S, Chi, J, Skeff, K. A pilot study of the chronology of present illness: restructuring the HPI to improve physician cognition and communication. J Gen Intern Med 2017;32:182–8. https://doi.org/10.1007/s11606-016-3928-3.Search in Google Scholar PubMed PubMed Central

5. Shi, L, Sun, J, Yang, Y, Ling, T, Wang, M, Gu, Y, et al.. Three-dimensional visual patient based on electronic medical diagnostic records. IEEE J Biomed Health Inform 2018;22:161–72. https://doi.org/10.1109/jbhi.2017.2702201.Search in Google Scholar PubMed

6. Park, H, Choi, J. V-Model: a new perspective for EHR-based phenotyping. BMC Med Inform Decis Mak 2014;14:90. https://doi.org/10.1186/1472-6947-14-90.Search in Google Scholar PubMed PubMed Central

7. Hirsch, JS, Tanenbaum, JS, Lipsky Gorman, S, Liu, C, Schmitz, E, Hashorva, D, et al.. HARVEST, a longitudinal patient record summarizer. J Am Med Inform Assoc 2015;22:263–74. https://doi.org/10.1136/amiajnl-2014-002945.Search in Google Scholar PubMed PubMed Central

8. Schmidt, HG, Boshuizen, HP. The impact of experience and case complexity on diagnostic reasoning in medicine. Acad Med 1993;68:290–5.Search in Google Scholar

9. Berner, ES, Graber, ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med 2008;121:S2–23. https://doi.org/10.1016/j.amjmed.2008.01.001.Search in Google Scholar PubMed

10. 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

11. 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

12. Redelmeier, DA, Tu, JV, Schull, MJ, Ferris, LE, Hux, JE. Problems for clinical judgement: 2. Obtaining a reliable past medical history. CMAJ 2001;164:809–13.Search in Google Scholar

13. Levy, AG, Scherer, AM, Zikmund-Fisher, BJ, Larkin, K, Barnes, GD, Fagerlin, A. Prevalence of and factors associated with patient nondisclosure of medically relevant information to clinicians. JAMA Netw Open 2018;1:e185293. https://doi.org/10.1001/jamanetworkopen.2018.5293.Search in Google Scholar PubMed PubMed Central

14. Cannarella, LR, 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

15. Seo, W, Jain, S, Le, V, Li, J, Zhang, Z, Singh, H, et al.. Designing patient-centered interventions for emergency care: participatory design study. JMIR Form Res 2025;9:e643610. https://doi.org/10.2196/63610.39938082.Search in Google Scholar

16. Simon, HA. The structure of ill-structured problems. Artif Intell 1973;4:181–201. https://doi.org/10.1016/0004-3702(73)90011-8.Search in Google Scholar

17. Shimizu, T. Horizontal and vertical tracing: a cognitive forcing strategy to improve diagnostic accuracy. Postgrad Med J 2020;96:581–3. https://doi.org/10.1136/postgradmedj-2020-137548.Search in Google Scholar PubMed

18. Wikipedia. Winged Victory of Samothrace. Available from: https://en.wikipedia.org/wiki/Winged_Victory_of_Samothrace#:∼:text=It%20is%20composed%20of%20a,shape%20of%20a%20ship’s%20bow.&text=The%20total%20height%20of%20the,(9%20ft%200%20in) [Accessed 07 Jan, 2025].Search in Google Scholar

19. Miyamoto, M. The complete Musashi: the book of five rings and other works. North Clarendon, VT: Tuttle publishing; 2018.Search in Google Scholar

20. Ishizuka, K, Ohira, Y, Uehara, T, Noda, K, Tsukamoto, T, Shikino, K, et al.. VAPES: a new mnemonic for considering paroxysmal disorders. Diagnosis (Berl) 2023;10:203–4. https://doi.org/10.1515/dx-2022-0132.Search in Google Scholar PubMed

21. Shimizu, T, Tokuda, Y. System 3 diagnostic process: the lateral approach. Int J Gen Med 2012;5:873–4. https://doi.org/10.2147/ijgm.s36859.Search in Google Scholar PubMed PubMed Central

22. Braun, KP, Rafay, MF, Uiterwaal, CSPM, Pontigon, AM, DeVeber, G. Mode of onset predicts etiological diagnosis of arterial ischemic stroke in children. Stroke 2007;38:298–302. https://doi.org/10.1161/01.str.0000254484.10680.c6.Search in Google Scholar PubMed

23. Henssge, C, Madea, B. Estimation of the time since death in the early postmortem period. Forensic Sci Int 2004;144:167–75. https://doi.org/10.1016/j.forsciint.2004.04.051.Search in Google Scholar PubMed

24. Pettijohn, KA, Thompson, AN, Tamplin, AK, Krawietz, SA, Radvansky, GA. Event boundaries and memory improvement. Cognition 2016;148:136–44. https://doi.org/10.1016/j.cognition.2015.12.013.Search in Google Scholar PubMed

25. Williams, S, Fiumara, K, Kachalia, A, Desai, S. Closing the loop with ambulatory staff on safety reports. Joint Comm J Qual Patient Saf 2020;46:44–50. https://doi.org/10.1016/j.jcjq.2019.09.009.Search in Google Scholar PubMed

26. Elwyn, G, Frosch, D, Thomson, R, Joseph-Williams, N, Lloyd, A, Kinnersley, P, et al.. Shared decision making: a model for clinical practice. J Gen Intern Med 2012;27:1361–7. https://doi.org/10.1007/s11606-012-2077-6.Search in Google Scholar PubMed PubMed Central

27. Marvel, MK, Epstein, RM, Flowers, K, Beckman, HB. Soliciting the patient’s agenda: have we improved? JAMA 1999;281:283–7. https://doi.org/10.1001/jama.281.3.283.Search in Google Scholar PubMed

28. Shimizu, T. DECLARE: a comprehensive, multifaceted cognitive forcing strategy to confront complex cases. Int J Gen Med 2023;16:1505–11. https://doi.org/10.2147/ijgm.s406165.Search in Google Scholar

29. Pixabay. Prism light spectrum optics [Internet]. Available from: https://pixabay.com/photos/prism-light-spectrum-optics-6174502/ [Accessed 20 March , 2025].Search in Google Scholar
Received: 2025-01-08
Accepted: 2025-03-31
Published Online: 2025-04-11

© 2025 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis
  4. Prenatal screening for genetic disorders: updated guidelines, proposed counseling, a holistic approach for primary health care providers in developing countries
  5. A scoping review of fever of unknown origin with normal serum C-reactive protein
  6. Mini Review
  7. Overview of dengue diagnostic limitations and potential strategies for improvement
  8. Opinion Papers
  9. Demystifying cognitive bias in the diagnostic process for frontline clinicians and educators; new words for old ideas
  10. Physicians’ prism: illuminating history with structured expertise
  11. Original Articles
  12. Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
  13. A synthesized differential diagnosis is associated with fewer diagnostic errors compared to an inventorial list
  14. Equity-Driven Diagnostic Excellence framework: An upstream approach to minimize risk of diagnostic inequity
  15. Two decades of autopsy-detected diagnostic errors in Japan
  16. Does management reasoning display context specificity? An exploration of sleep loss and other distracting situational (contextual) factors in clinical reasoning
  17. Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths
  18. Racial and ethnic disparities in pediatric emergency department patients with missed opportunities for diagnostic excellence
  19. Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
  20. “Innumerable” lesion burden on brain MRI ‒ a diagnostic approach
  21. Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis
  22. Exploring emergency department providers’ uncertainty in neurological clinical reasoning
  23. Analytical performance and user-friendliness of four point-of-care measuring systems for monitoring prothrombin time international normalized ratio in the hands of the intended users
  24. Fetal hematological phenotypes of various hemoglobinopathies and demonstration of embryonic hemoglobins on capillary electrophoresis: a large cohort data from prenatal screening program
  25. Development and assessment of autoverification system for routine coagulation assays in inpatient and outpatient settings of tertiary care hospital: algorithm performance and impact on laboratory efficiency
  26. Validation of new, circulating biomarkers for gliomas
  27. Short Communications
  28. Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula
  29. Comparative evaluation of routine coagulation testing on Stago sthemO 301 and Werfen ACL TOP 750
  30. Letters to the Editor
  31. Reversible systemic vasoconstriction syndrome: a new diagnostic family of generalized vasospasm in multiple organs
  32. The value of designating symptoms as “vague” in diagnosis
  33. Immunoglobulin E in an inverted skin-prick test for rapid detection of cutaneous antigens
https://doi.org/10.1515/dx-2025-0003
Keywords for this article
improving diagnosis; diagnostic error; diagnostic excellence; clinical reasoning; medical history

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis
  4. Prenatal screening for genetic disorders: updated guidelines, proposed counseling, a holistic approach for primary health care providers in developing countries
  5. A scoping review of fever of unknown origin with normal serum C-reactive protein
  6. Mini Review
  7. Overview of dengue diagnostic limitations and potential strategies for improvement
  8. Opinion Papers
  9. Demystifying cognitive bias in the diagnostic process for frontline clinicians and educators; new words for old ideas
  10. Physicians’ prism: illuminating history with structured expertise
  11. Original Articles
  12. Implementation of a curriculum on communicating diagnostic uncertainty for clerkship-level medical students: a pseudorandomized and controlled study
  13. A synthesized differential diagnosis is associated with fewer diagnostic errors compared to an inventorial list
  14. Equity-Driven Diagnostic Excellence framework: An upstream approach to minimize risk of diagnostic inequity
  15. Two decades of autopsy-detected diagnostic errors in Japan
  16. Does management reasoning display context specificity? An exploration of sleep loss and other distracting situational (contextual) factors in clinical reasoning
  17. Cognitive biases in osteopathic diagnosis: a mixed study among French osteopaths
  18. Racial and ethnic disparities in pediatric emergency department patients with missed opportunities for diagnostic excellence
  19. Diagnostic accuracy of non-mydriatic fundus photography as a triage and telemedicine tool for patients with vision loss
  20. “Innumerable” lesion burden on brain MRI ‒ a diagnostic approach
  21. Factors associated with positive findings of deep infection on computed tomography among patients with extremity cellulitis
  22. Exploring emergency department providers’ uncertainty in neurological clinical reasoning
  23. Analytical performance and user-friendliness of four point-of-care measuring systems for monitoring prothrombin time international normalized ratio in the hands of the intended users
  24. Fetal hematological phenotypes of various hemoglobinopathies and demonstration of embryonic hemoglobins on capillary electrophoresis: a large cohort data from prenatal screening program
  25. Development and assessment of autoverification system for routine coagulation assays in inpatient and outpatient settings of tertiary care hospital: algorithm performance and impact on laboratory efficiency
  26. Validation of new, circulating biomarkers for gliomas
  27. Short Communications
  28. Using language to evaluate curricular impact: a novel approach in assessing clinical reasoning curricula
  29. Comparative evaluation of routine coagulation testing on Stago sthemO 301 and Werfen ACL TOP 750
  30. Letters to the Editor
  31. Reversible systemic vasoconstriction syndrome: a new diagnostic family of generalized vasospasm in multiple organs
  32. The value of designating symptoms as “vague” in diagnosis
  33. Immunoglobulin E in an inverted skin-prick test for rapid detection of cutaneous antigens
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