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J Gen Intern Med. 2016 Apr;31(4):435-7. doi: 10.1007/s11606-016-3592-7. Epub 2016 Jan 26.

What's in a Label? Is Diagnosis the Start or the End of Clinical Reasoning?

Author information

1
Department of Medicine, Division of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA. ilgen@uw.edu.
2
Center for Leadership & Innovation in Medical Education, University of Washington School of Medicine, Seattle, WA, USA. ilgen@uw.edu.
3
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
4
Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada.
5
Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

Diagnostic reasoning has received substantial attention in the literature, yet what we mean by "diagnosis" may vary. Diagnosis can align with assignment of a "label," where a constellation of signs, symptoms, and test results is unified into a solution at a single point in time. This "diagnostic labeling" conceptualization is embodied in our case-based learning curricula, published case reports, and research studies, all of which treat diagnostic accuracy as the primary outcome. However, this conceptualization may oversimplify the richly iterative and evolutionary nature of clinical reasoning in many settings. Diagnosis can also represent a process of guiding one's thoughts by "making meaning" from data that are intrinsically dynamic, experienced idiosyncratically, negotiated among team members, and rich with opportunities for exploration. Thus, there are two complementary constructions of diagnosis: 1) the correct solution resulting from a diagnostic reasoning process, and 2) a dynamic aid to an ongoing clinical reasoning process. This article discusses the importance of recognizing these two conceptualizations of "diagnosis," outlines the unintended consequences of emphasizing diagnostic labeling as the primary goal of clinical reasoning, and suggests how framing diagnosis as an ongoing process of meaning-making might change how we think about teaching and assessing clinical reasoning.

KEYWORDS:

clinical reasoning; diagnosis; diagnostic reasoning; medical decision-making; problem-solving

PMID:
26813111
PMCID:
PMC4803694
DOI:
10.1007/s11606-016-3592-7
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The authors declare that they do not have a conflict of interest. Funders This work was supported by an internal grant from the University of Washington’s Center for Leadership & Innovation in Medical Education (CLIME).

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