Adjusting disease patterns with clinical pictures rather than following mindlines: clinical thinking in Germany
I enjoyed the article of Gabbay and le May as they put into focus the
“processes of collective “sense making” by which knowledge, both explicit
and tacit and from whatever sources, is negotiated, constructed, and
internalised in routine practice.” They identified mindlines replacing
guidelines in daily practice.
If we assume that these processes of collective sense making are
shaped by, among other factors, culture and training, it would be
interesting to see, if the social construct of mindlines will be a valid
approximation for other countries as well. My hypothesis for Germany would
be that a similar study would reveal neither mindlines nor other linear
structures.
Instead of the linear, algorithm-driven process commonly used in
Anglo-Saxon practice, the process of diagnosing in Germany might better be
described as an adjusting of memorised disease patterns to clinical
pictures of the patients. The experience of a doctor is reflected by an
increased number of actively retrievable disease patterns. The linguistic
equivalent would be the term Krankheitsbild, which could be literally
translated as “disease image” rather than “clinical picture” and is
thought of representing the essential character of a disease rather than
the mere symptoms. Krankheitsbilder are structuring lecture series for
medical students and seem to shape the structure that underlies clinical
thinking in Germany.
Acknowledging that this is still a mind game: to overcome the deep-
rooted resistance against evidence based medicine in Germany clinical
practice would need to win minds and hearts. Accepting that the
predominating “processes of collective sense making”, namely adjusting
disease patterns with clinical pictures, might not be fully compatible
with following linear algorithm-oriented guidelines would be a first step.
----------
Place of work (lack of space in the corresponding box)
Department of Epidemiology, Social Medicine, and Health System Research,
Hannover Medical School,
30623 Hannover,
Germany
Competing interests:
None declared
Competing interests:
No competing interests
11 November 2004
Ansgar Gerhardus
Research Associate
Department of Epidemiology, Social Medicine, and Health System Research; Hannover Medical School
Rapid Response:
Adjusting disease patterns with clinical pictures rather than following mindlines: clinical thinking in Germany
I enjoyed the article of Gabbay and le May as they put into focus the
“processes of collective “sense making” by which knowledge, both explicit
and tacit and from whatever sources, is negotiated, constructed, and
internalised in routine practice.” They identified mindlines replacing
guidelines in daily practice.
If we assume that these processes of collective sense making are
shaped by, among other factors, culture and training, it would be
interesting to see, if the social construct of mindlines will be a valid
approximation for other countries as well. My hypothesis for Germany would
be that a similar study would reveal neither mindlines nor other linear
structures.
Instead of the linear, algorithm-driven process commonly used in
Anglo-Saxon practice, the process of diagnosing in Germany might better be
described as an adjusting of memorised disease patterns to clinical
pictures of the patients. The experience of a doctor is reflected by an
increased number of actively retrievable disease patterns. The linguistic
equivalent would be the term Krankheitsbild, which could be literally
translated as “disease image” rather than “clinical picture” and is
thought of representing the essential character of a disease rather than
the mere symptoms. Krankheitsbilder are structuring lecture series for
medical students and seem to shape the structure that underlies clinical
thinking in Germany.
Acknowledging that this is still a mind game: to overcome the deep-
rooted resistance against evidence based medicine in Germany clinical
practice would need to win minds and hearts. Accepting that the
predominating “processes of collective sense making”, namely adjusting
disease patterns with clinical pictures, might not be fully compatible
with following linear algorithm-oriented guidelines would be a first step.
----------
Place of work (lack of space in the corresponding box)
Department of Epidemiology, Social Medicine, and Health System Research,
Hannover Medical School,
30623 Hannover,
Germany
Competing interests:
None declared
Competing interests: No competing interests