Lessons in clinical reasoning - pitfalls, myths, and pearls: a case of persistent dysphagia and patient partnership.

IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL
Diagnosis Pub Date : 2024-09-03 eCollection Date: 2024-11-01 DOI:10.1515/dx-2024-0061
Yumi Otaka, Yukinori Harada, Andrew Olson, Takuya Aoki, Taro Shimizu
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引用次数: 0

Abstract

Objectives: Diagnostic excellence underscores the patient-centered diagnosis and patient engagement in the diagnostic process. In contrast to a patient-centered diagnosis, a doctor-centered diagnosis with a lack of patient engagement may inhibit the diagnostic process due to the lack of responsibility, disrupted information, and increased effect of cognitive biases, particularly in a situation where multiple physicians are involved. In this paper, we suggest a promising idea to enhance patient engagement in the diagnostic process by using written information by a patient about their perspective and experience, which can fill the gaps needed for diagnosis that doctors cannot find alone.

Case presentation: A 38-year-old woman developed chest pain, which gradually worsened during the following two years. For two years, she was evaluated in multiple departments; however, no definitive diagnosis was made, and her condition did not improve. During this evaluation, she searched her symptoms and image findings online. She reached a possible diagnosis of 'esophageal achalasia.' Still, she could not tell her concerns to any physicians because she felt that her concerns were not correctly recognized, although she showed her notes that her symptoms were recorded. She finally consulted the department of internal medicine, where her notes and previous test results were thoroughly reviewed. The final diagnosis of esophageal achalasia was confirmed.

Conclusions: Doctors must organize an environment where patients can freely express their thoughts, emotions, and ideas regarding their diagnosis. Cogenerating visit notes using patient input through written communication can be a promising idea to facilitate patient engagement in the diagnostic process.

临床推理的经验教训--陷阱、神话和珍珠:一个持续性吞咽困难和患者合作的案例。
目标:卓越诊断强调以患者为中心的诊断和患者参与诊断过程。与以患者为中心的诊断相比,以医生为中心而缺乏患者参与的诊断可能会由于缺乏责任感、信息混乱和认知偏差的影响而抑制诊断过程,尤其是在有多名医生参与的情况下。在本文中,我们提出了一个很有前景的想法,即利用患者提供的有关其观点和经历的书面信息来提高患者在诊断过程中的参与度,从而填补医生无法单独发现的诊断空白:一名 38 岁的女性出现胸痛,并在随后的两年中逐渐恶化。两年来,她接受了多个科室的检查,但都没有确诊,病情也没有好转。在评估期间,她在网上搜索了自己的症状和图像结果。她得出了 "食道贲门失弛缓症 "的可能诊断。尽管如此,她还是无法将自己的担忧告诉任何医生,因为她觉得自己的担忧没有得到正确的认识,尽管她出示了记录她症状的笔记。最后,她来到内科就诊,内科详细查看了她的病历和之前的检查结果。最后确诊为食道贲门失弛缓症:医生必须营造一种环境,让患者能够自由表达他们对诊断的想法、情绪和观点。利用患者通过书面交流提出的意见共同生成就诊记录,是促进患者参与诊断过程的一个很有前景的想法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diagnosis
Diagnosis MEDICINE, GENERAL & INTERNAL-
CiteScore
7.20
自引率
5.70%
发文量
41
期刊介绍: Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.  Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error
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