User login
Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.
KNOWLEDGE
Hospitalists should be able to:
Describe the prevalence of common disease states to the local patient population.
Explain appropriate resources to determine prevalence and incidence of disease states.
Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.
Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.
Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.
Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.
Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.
Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.
Name appropriate sources of information regarding evidence based clinical decision making.
Describe the factors that account for excessive or indiscriminate testing.
SKILLS
Hospitalists should be able to:
Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.
Perform a physical examination to further refine the diagnostic hypothesis.
Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.
Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.
Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.
Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.
Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.
Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.
Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.
Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.
Lead, coordinate or participate in the development of clinical care pathways.
Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.
Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.
KNOWLEDGE
Hospitalists should be able to:
Describe the prevalence of common disease states to the local patient population.
Explain appropriate resources to determine prevalence and incidence of disease states.
Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.
Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.
Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.
Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.
Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.
Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.
Name appropriate sources of information regarding evidence based clinical decision making.
Describe the factors that account for excessive or indiscriminate testing.
SKILLS
Hospitalists should be able to:
Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.
Perform a physical examination to further refine the diagnostic hypothesis.
Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.
Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.
Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.
Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.
Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.
Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.
Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.
Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.
Lead, coordinate or participate in the development of clinical care pathways.
Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.
Diagnostic decision making refers to the process of evaluating a patient complaint to develop a differential diagnosis, design a diagnostic evaluation, and arrive at a final diagnosis. Hospitalists frequently care for acutely ill patients with undifferentiated symptoms such as shortness of breath or chest pain. Establishing a correct diagnosis in these situations allows for timely therapeutic interventions and eliminates unnecessary diagnostic evaluation. Hospitalists assess disease prevalence, pre‐test probability, and post‐test probability to make a diagnostic decision. By using efficient and timely diagnostic decision making, hospitalists can positively impact the quality and cost of medical care.
KNOWLEDGE
Hospitalists should be able to:
Describe the prevalence of common disease states to the local patient population.
Explain appropriate resources to determine prevalence and incidence of disease states.
Formulate a pretest probability using initial history, physical examination, and preliminary diagnostic information when available.
Define and differentiate problem solving strategies, including hypothesis testing and pattern recognition.
Define and differentiate prevalence, pre‐test probability, test characteristics (including sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios), and post‐test probability.
Describe the concepts that underlie Bayes theorem, and how it is used in diagnostic decision making.
Describe the relevance of sensitivity and specificity in interpreting diagnostic findings.
Describe the sensitivity and specificity for common clinical syndromes of key clinical presentations and diagnostic findings.
Name appropriate sources of information regarding evidence based clinical decision making.
Describe the factors that account for excessive or indiscriminate testing.
SKILLS
Hospitalists should be able to:
Obtain a targeted history, eliciting symptoms and data that help refine the diagnostic hypothesis.
Perform a physical examination to further refine the diagnostic hypothesis.
Order the indicated tests based on knowledge of disease prevalence, clinical uncertainty, and risk of morbidity and mortality.
Calculate post‐test probabilities of disease using pre‐test probabilities and likelihood ratios.
ATTITUDES
Hospitalists should be able to:
Communicate with patients and families to explain the differential diagnosis and evaluation of the patient's presenting symptoms.
Communicate with patients and families to explain how testing will change the scope of diagnostic possibilities.
Determine when sufficient evaluation has occurred, in the absence of diagnostic certainty.
Communicate with other physicians, trainees and healthcare providers to explain the rationale for use of diagnostic tests.
Recognize that each test should be preceded by a conscious decision to change or maintain the clinical care or initiate further diagnostic evaluation as indicated, based on the test results.
Analyze the value of each diagnostic test, especially testing procedures that carry significant patient discomfort or risk.
Appreciate that all tests have false positive and false negative results, and rigorously scrutinize or repeat the testing when the result is in question.
Lead, coordinate or participate in the development of clinical care pathways.
Incorporate the principles of evidenced based medicine, health care costs, and patient preferences and values into each patient's diagnostic evaluation.
Copyright © 2006 Society of Hospital Medicine