Published 22 September 2009, doi:10.1136/bmj.b3490
Cite this as: BMJ 2009;339:b3490

Practice

Diagnosis in General Practice

Iterative diagnosis

¹ Faculty of Health Sciences, McMaster University,1200 Main St W, Hamilton, ON, Canada L8N 3Z5, ² Painswick GL6 6TY

Strategies for improving the pattern recognition involved in making a correct diagnosis amount to forcing yourself to use analytical reasoning; diagnosis of vertigo (doi:10.1136/bmj.b3493) is an example

The first 150 words of the full text of this article appear below.

The traditional model of diagnosis is one of initial collection of information in the history and examination, followed by deductive steps to reach a diagnosis. We suspect that most clinicians do not recognise or use this process.

A more realistic model was formulated by Elstein and Schwarz 25 years ago.¹ It was called the hypothetico-deductive model, but we will call it the process of iterative diagnosis. This model recognises that clinical reasoning usually involves the clinician generating one or more possible hypotheses early on in the consultation (often, but not always, by pattern recognition²) and then recurrently—iteratively—testing these. Clinicians use many such shortcuts (heuristics) in clinical reasoning. This is not a fault: the shortcuts are typically correct and allow them to arrive at a working diagnosis with the minimum of delay, while avoiding excessive testing and anxiety. Exhaustive data collection without hypotheses—the medical student’s history and examination—usually does not . . . [Full text of this article]

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