Here is a three step model for Clinical Reasoning to help you avoid bias and make better clinical decisions.
Step one: Create a problem representation
Your Problem Representation is a mini presentation of the patient’s problem. It should have three parts:
Epidemiology: Who is the patient? (Sex, Age, Risks)
What is the context? ( Underlying conditions and habits, pertinent family history)
Clinical Syndrome: What is the problem? (Uses Chronology of the current illness, using SEMANTIC QUALIFIERS*
*Semantic qualifiers are adjectives, usually paired that help separate one set of diagnoses from another. (Eg. Acute/subacute/chronic, painful/painless, Symmetric/asymmetric)
Remember this guy?
Let’s imagine what his Problem Representation is
The patient is a 35 year old man appearing much older than his stated age. He has a ten pack year-year smoking history. He presents to the Emergency Department complaining of severe shortness of breath and exercise intolerance. The shortness of breath has been progressive over the last 2 years and he has noted an unplanned weight loss of 20 pounds over the last 8 months.
What are the features to note:
35 year old man
appearing much older than his stated age
Ten pack year-year smoking history
Severe (semantic qualifier) shortness of breath and exercise intolerance.
Progressive (semantic qualifier) over the last 2 years
Unplanned (semantic qualifier) weight loss of 20 pounds over the last 8 months