Foreword | p. vii |
Preface to the Second Edition | p. ix |
Acknowledgments | p. xiii |
A Note About the Book's Format | p. xiv |
The Processes of Clinical Reasoning | |
Overview | p. 3 |
Introduction | p. 3 |
Diagnosis is an Inferential Process | p. 5 |
Problem-Solving Strategies | p. 5 |
Diagnosis Based on Hypothesis Generation and Testing | p. 5 |
Alternate Concepts of Diagnostic Strategies | p. 6 |
Therapeutic Principles | p. 6 |
Linking Diagnosis and Treatment | p. 7 |
Diagnostic Hypothesis Generation | p. 8 |
Hypotheses and Cues | p. 8 |
The Cognitive Basis of Hypothesis Generation | p. 8 |
Hypotheses as a Context | p. 9 |
Expertise and Error | p. 9 |
Refinement of Diagnostic Hypotheses | p. 11 |
Where Refinement Begins and Ends | p. 11 |
Context and Diagnostic Classification | p. 11 |
Hypothesis Evolution | p. 12 |
Sequence of Data Collection | p. 12 |
Reducing Diagnostic Uncertainty | p. 13 |
The Differential Diagnosis | p. 14 |
Relation to Formal Probabilistic Approach | p. 14 |
Use and Interpretation of Diagnostic Tests | p. 15 |
The Function of Tests | p. 15 |
Quantifying Testing Decisions | p. 15 |
Sensitivity and Specificity | p. 16 |
Bayes' Rule | p. 17 |
Testing Principles | p. 18 |
Bayesian Revision for Multiple Results | p. 19 |
Bayesian Revision for Multiple Diseases With Multiple Attributes | p. 21 |
Pragmatic Considerations in the Probabilistic Approach | p. 22 |
Interpreting Results | p. 23 |
When to Test | p. 23 |
The Threshold Concept | p. 24 |
The Therapeutic Threshold | p. 24 |
Testing Thresholds | p. 25 |
Causal Reasoning | p. 28 |
Definition | p. 28 |
Using a Causal Model | p. 29 |
Where in the Diagnostic Process Does Causal Reasoning Fit? | p. 29 |
Explaining Relations Between Variables | p. 30 |
Diagnostic Verification | p. 31 |
Definition | p. 31 |
Criteria of Validity | p. 31 |
Premature Closure | p. 31 |
The Penultimate Result: A Working Diagnosis | p. 32 |
Therapeutic Decision Making | p. 33 |
Principles | p. 33 |
Treatment Under Conditions of Uncertainty | p. 33 |
When the Value of Therapeutic Choices is Close | p. 34 |
Incommensurate Options | p. 34 |
Quantitative Therapeutic Decision Making | p. 34 |
Examining Evidence | p. 36 |
Introduction | p. 36 |
Evidence-Based Medicine | p. 36 |
Asking Questions | p. 36 |
Searching for Evidence | p. 37 |
Summarizing and Appraising Evidence | p. 37 |
Applying the Evidence | p. 37 |
Practice Guidelines | p. 38 |
Cognitive Errors | p. 39 |
Scope | p. 39 |
Classification | p. 39 |
Some Errors may have a Psychological Origin | p. 39 |
The Nature of Cognitive Errors | p. 39 |
Cognitive Biases in the Laboratory | p. 40 |
Consequences of Cognitive Biases | p. 40 |
Strategies for Avoiding Cognitive Errors | p. 41 |
Some Cognitive Concepts | p. 42 |
Cognitive Science | p. 42 |
Studying Mental Processes | p. 42 |
The Structure of Memory | p. 42 |
Search Strategies | p. 44 |
Characteristics of Expertise | p. 46 |
Learning Clinical Problem Solving | p. 48 |
Facts Versus Process | p. 48 |
Pedagogic Principles | p. 49 |
A Specific Example | p. 49 |
The Goal Should Determine the Format | p. 50 |
Learning by Instantiation | p. 50 |
Learning Clinical Problem Solving Versus Problem-Based Learning | p. 51 |
Cognition at the Bedside: A Set of Examples | |
Introduction to the Cases | p. 55 |
Diagnostic Hypothesis Generation | p. 56 |
Generation of Diagnostic Hypotheses | p. 56 |
Hypothesis Triggering by an Expert | p. 60 |
A Diagnostic Coup | p. 63 |
A Quick and Accurate Solution | p. 66 |
Better Late Than Never | p. 69 |
A Hit After a Miss | p. 73 |
The Critical Role of Context in the Diagnostic Process | p. 76 |
A Masked Marauder | p. 81 |
A Serious Lack of Focus | p. 84 |
Refinement of Diagnostic Hypotheses | p. 89 |
What is a Differential Diagnosis? | p. 89 |
An Orderly, Sequential Approach | p. 94 |
Weak Reasoning: Diagnosis by Drug Reaction | p. 96 |
Narrowing Down the Diagnostic Options | p. 100 |
A Picture is Worth a Thousand Words | p. 104 |
Strategies of Information Gathering | p. 108 |
A Fatal Flaw in Sutton's Law | p. 113 |
How to Disregard Red Herrings | p. 118 |
Discrimination: The Problem of Look-Alikes | p. 121 |
Location, Location, Location | p. 125 |
Use and Interpretation of Diagnostic Tests | p. 128 |
Interpreting a Negative Test Result | p. 128 |
Diagnosis and the Risks of the Primrose Path | p. 131 |
Searching for a Pony | p. 134 |
Interpreting Hoofbeats: Can Bayes Help Clear the Haze? | p. 137 |
Short-Circuiting the Diagnostic Process | p. 143 |
The Bypass on the Way to the Bypass | p. 145 |
It is What You Believe That Counts | p. 148 |
Renal Rescue by Reverend Bayes | p. 152 |
A Diagnostic Fluke | p. 155 |
Surprise! | p. 157 |
Tripping Over Technology | p. 161 |
The Probability of a Probability | p. 165 |
Causal Reasoning | p. 169 |
Judging Causality | p. 169 |
Post Hoc, Ergo Propter Hoc | p. 171 |
The Case for Causal Reasoning | p. 175 |
The Tricky Task of Attributing Causation | p. 180 |
The Right Answer for the Wrong Reason | p. 183 |
Diagnostic Verification | p. 186 |
A Point-By-Point Dissection of Clinical Reasoning | p. 186 |
Leaving No Stone Unturned | p. 188 |
Verification | p. 192 |
A Meticulous Approach | p. 196 |
A Diagnostic Quandary | p. 199 |
Diagnosis by Fiat | p. 203 |
Iron Pyrite and Diagnostic Confirmation | p. 207 |
Therapeutic Decision Making | p. 209 |
The Surgeon Opts to Operate: Why? | p. 209 |
Treat or Keep Testing? | p. 211 |
Watch and Wait, or Operate? | p. 216 |
An Apple or an Orange? | p. 218 |
Examining Evidence | p. 223 |
A Difficult Tradeoff | p. 223 |
Making Judgments When the Evidence is Not Definitive | p. 225 |
Using and Citing Published Evidence | p. 227 |
A Little Math Makes the Medicine Go Down | p. 229 |
A Rewarding Pursuit of Certainty | p. 234 |
Treating Before Knowing | p. 239 |
Cognitive Errors | p. 244 |
A Defective Detective | p. 244 |
Remedies for Faulty Hypothesis Generation | p. 248 |
A Disaster Averted | p. 252 |
Derailed by the Availability Heuristic | p. 255 |
Wrong Diagnosis, Wrong Tests, Wrong Treatment | p. 262 |
Reconsidering Failures of Therapy | p. 266 |
The Cheetah and the Snail | p. 267 |
A Collection of Cognitive Diagnostic Errors | p. 271 |
Some Cognitive Concepts | p. 275 |
A Message about Methods | p. 275 |
Memory: How We Overcome its Limitations | p. 279 |
Diagnosis and the Structure of Memory; Disease Polymorphism and Mental Models | p. 281 |
Intuitive and Inspirational, or Inductive and Incremental? | p. 286 |
Knowledge and Clinical Expertise | p. 291 |
Learning Clinical Problem Solving | p. 295 |
Learning Clinical Reasoning from Examples | p. 295 |
Making a Silk Purse out of a Sow's Ear | p. 299 |
Optimizing Case Discussions | p. 304 |
Glossary | p. 308 |
Bibliography | p. 313 |
Index | p. 325 |
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