Overview of Diagnostic Reasoning: Hypothetical-Deductive Strategy; Problem Representation; Semantic Qualifiers; Illness Scripts; Pattern Recognition and Prototypes

ABSTRACT

Context This current paper is a non-systematic review of diagnostic reasoning exclusive of the Bayesian model which we considered a decision-making stratagem. The paper reviews primarily the literature on hypothetical-deductive reasoning and pattern recognition; the two archetypes of analytical and non-analytical reasoning; respectively. Though a lot of work has been reported in this field internationally our medical training in Zambia does not overtly tackle diagnostic reasoning and expectedly not many clinicians in Zambia are acquainted with the subject matter. Nevertheless; our clinicians pass on to future generations; by apprenticeship; their diagnostic reasoning processes; but to be effective educators clinicians must understand diagnostic reasoning well. Purpose: The purpose of the current paper is threefold 1) to share the generally accepted concepts in diagnostic reasoning in order to help clinicians become more effective educators in the clinical settings; 2) provoke clinicians and students alike to critically consider the subject of diagnostic reasoning and 3) also to inform readers about prospective research initiatives at the University which intend to investigate diagnostic reasoning practices of Zambian-educated medical graduates. Conclusions: Generally; there are three accepted diagnostic reasoning models; i.e.; hypothetical-deductive reasoning; pattern recognition; and pathognomonic recognition of signs and symptoms. These are categorised as analytical methods (principally the hypothetical-deductive strategy) and non-analytical methods (pattern recognition and pathognomonic approaches). The Diagnostic Reasoning Research - Zambia Project (DRR-Z) will be the first in Zambia to study diagnostic reasoning processes of graduates from University of Zambia School of Medicine. Clinicians who are well informed about the diagnostic reasoning process can teach it more effectively