UNIVERSAL CLINICAL REASONING

Getting the correct diagnosis as soon as possible, without unnecessary tests or trials of failed treatment, is the goal and hallmark of excellent healthcare. Clinical reasoning is central to the goal of rapidly deducing the correct clinical diagnosis whilst continuing to be safe and careful. This reasoning is also required to make optimal, patient-centred decisions afterwards.

Commonplace healthcare and training are far from attaining this goal. Inability to correctly diagnose patients is often accompanied by mistakes, wastage, and sometimes allegations of medical malpractice. Some countries like the USA have great wealth and advanced technology, yet consistently have poor overall outcomes and significant medicolegal litigation. Healthcare training is fragmented and flawed, with multiple styles and approaches without any unifying, clear path for learners.

This book aims to address all of those limitations.

Clinical reasoning is defined in a universal, simple and practical manner for all healthcare trainees, professionals and leaders. The learning journey for this skill is described, and applies for any patient in any setting. In so doing, this method aims to accelerate the acquisition of competence, and increase the extent of achieved competence.

Contents:

• Introduction
• The Clinical Approach:
• What is Clinical Reasoning?
• The Initial Information, Categories of Diagnostic Information, and Illness Scripts
• What is a Diagnosis?
• Generating Early Differential Diagnoses: The 3-Minute Habit
• Targeted Evaluation: History
• Targeted Evaluation: Physical Examination
• Epidemiology and Risk Factors
• Putting It All Together: The Most Likely Diagnosis
• Diagnostic Puzzles: How to Handle Them
• Pathophysiology in Reasoning
• Ruling Out: When, Why and How
• Common Mistakes in the Clinical Approach
• Gathering Additional Information to Manage Patients
• Anticipatory Care
• Quiz: Clinical Approach
• Decision Making: Tests:
  • Patient-Centred Testing
  • Diagnostic Differentiation: Likelihood Ratios
  • Decision Thresholds for Diagnostic Testing and Treatment
  • Counselling: Tests
  • Interpreting Test Results
  • Understanding Common Laboratory Tests
  • Common Mistakes in Testing
  • Quiz: Tests
• Decision-Making: Treatment:
  • Treatment Decisions
  • Diagnosis: Disease, Severity and Treatment
  • Applied Clinical Reasoning for Improved Healthcare
  • Common Mistakes in Treatment
  • Quiz: Treatment
• Monitoring:
  • Follow-Up
  • Tackling the Chronic Disease
• Clinical Reasoning, Ignored:
  • Deceit
  • Tiers of Performance
  • Mistakes: What to Do
  • Theoretical Disease Approaches
  • Guidelines and Protocols
  • School
  • Hospital
• Wrapping Up:
  • Summary of the Clinical Approach, Diagnosis and Management
  • Answers to Quizzes
  • Closing
  • Additional Resources
  • Glossary (and Significance in Clinical Reasoning)
  • How This Came About

Readership: Healthcare teachers and schools for the purpose of improving teaching at individual and school level; Researchers, research regulatory and ethics boards, and reviewers as an introduction to impactful, applicable design and conduct of clinically-relevant diagnostic and therapeutic studies; Administrators, system designers (including healthcare software) and government officials as an introduction to recognizing and incorporating manifestations of robust clinical reasoning systematically to enshrine and incentivize robust, patient-centred healthcare; Anyone else who wants to understand effective, patient-centred diagnosis and decision-making.

'Dr Soh Jian Yi's book is a must read to master the three tasks of clinical practice namely: making a correct, current diagnosis; gathering information for optimal management of the clinical problems at hand; and making optimal healthcare decisions in partnership with the patient being attended to.' - Associate Professor Goh Lee GanSenior Consultant and Honorary Fellow, Department of Family MedicineYong Loo Lin School of Medicine, and National University Health System, Singapore

Key Features:

• Competing titles, literature and online platforms provide descriptors or substitutes for clinical reasoning, which is not the same as defining what clinical reasoning is. With this clarity of reasoning as is, comes the ability to teach, assess and correct it — something which has never been previously possible in any form. Thus, there are no actual competitors in terms of content or usefulness. At least 90% of the material is totally new. What little that looks familiar in literature — such as decision threshold theory or illness scripts — has been simplified such that there is little resemblance to the complex forms in the original papers, whilst simultaneously teaching their real-world application universally
• This book treats clinical reasoning as a single unifying topic, broken into discrete chunks to embed each component into the mind of the learner and teacher