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Risk and Reasoning in Clinical Diagnosis is an accessible and readable look at the medical diagnostic process. Based on 30 years experience as a primary care clnician, the author presents insights and concepts developed in cognitive psychology that bear on the diagnostic process, reviews what recent evidence tells us about diagnosis, and suggests specific, practical steps aimed at improving diagnosis in medical training and practice.
List of contents
- Dedication and Acknowledgements
- Preface
- 1. Introduction
- 2. Human Cognition: Trying to Make Sense of the World
- 3. Diagnosis Terms: Meanings, Classifications, and Potential Misunderstandings
- 4. Diagnostic Reasoning
- 5. Probability and Uncertainty
- 6. Diagnostic Triumphs and Disasters
- 7.Safeguards: Opportunities and Obstacles
- Further Reading
- Appendix 1: Croskerry's List of 50 common biases
About the author
Cym Ryle is a General Practitioner with the UK's National Health Service. He currently serves in locum posts in rural Scotland.
Summary
Accurate diagnosis is the foundation of medical practice, but at the start of the diagnostic process, uncertainty is inevitable. The clinician's skills and cognitive attributes determine the quality of the initial differential diagnosis and thus the crucial first phases of investigation and treatment; mistakes are often self-propagating. Diagnostic error is a major cause of avoidable morbidity and mortality, and is the commonest reason for successful litigation.
Risk and Reasoning in Clinical Diagnosis is an accessible and readable look at the diagnostic process. Dr. Cym Ryle presents the insights and concepts developed in cognitive psychology which have led to the consensus that in all domains human reasoning is primarily driven by unconscious, intuitive mechanisms; the contribution of structured, analytical thinking is variable and inconsistent. He notes that the risk of error is inseparable from these mechanisms.
Dr. Ryle then develops a description of the diagnostic process which encompasses its form, strengths and fallibility, and illustrates this description with examples from his work as a general practitioner. He argues that improving diagnostic accuracy should be a priority, and that there is sufficient evidence to guide changes in medical training, in clinical practice, and in the culture and organisation of our institutions. He identifies specific, practical steps that can be taken by individual clinicians and by clinical teams, suggests priorities for action in our institutions, and considers the obstacles to progress.
Additional text
[...] the author presents an extremely engaging and useful series of case studies from his own clinical experience that illustrate the successes and the pitfalls in diagnostic reasoning. These cases put real flesh on the theoretical skeleton and add immensely to the book. Clinicians will identify strongly with these experiences. At the same time non-clinicians reading the book will gain a considerable understanding of the actual challenges facing the clinician in the real- world setting.
