{"title":"Diagnostic uncertainty in physicians' reasoning: a structured approach using BANI and GRACE<sub>2</sub>.","authors":"Taro Shimizu","doi":"10.1515/dx-2025-0059","DOIUrl":null,"url":null,"abstract":"<p><p>Diagnostic uncertainty remains a persistent challenge in improving diagnostic practice, particularly for individual physicians. This paper applies the BANI (Brittle, Anxious, Nonlinear, Incomprehensible) framework to examine the nature of uncertainty encountered by physicians. Using clinical case examples, I demonstrate how BANI manifests in the diagnostic process and propose GRACE<sub>2</sub>, a six-element behavioral framework designed to support physicians in managing diagnostic uncertainty. GRACE<sub>2</sub> integrates cognitive flexibility, adaptive reasoning, and empathic communication. Together with BANI, it offers a structured and actionable approach to enhancing physicians' diagnostic decision-making, thereby contributing to the broader goal of improving diagnostic safety for patients.</p>","PeriodicalId":11273,"journal":{"name":"Diagnosis","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diagnosis","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1515/dx-2025-0059","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Diagnostic uncertainty remains a persistent challenge in improving diagnostic practice, particularly for individual physicians. This paper applies the BANI (Brittle, Anxious, Nonlinear, Incomprehensible) framework to examine the nature of uncertainty encountered by physicians. Using clinical case examples, I demonstrate how BANI manifests in the diagnostic process and propose GRACE2, a six-element behavioral framework designed to support physicians in managing diagnostic uncertainty. GRACE2 integrates cognitive flexibility, adaptive reasoning, and empathic communication. Together with BANI, it offers a structured and actionable approach to enhancing physicians' diagnostic decision-making, thereby contributing to the broader goal of improving diagnostic safety for patients.
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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