The Poison Review

The Mechanics of Reasoning. Dhaliwal G. JAMA 2011;306:918-919.

Full Text

It ain’t tox, but Gurpreet Dhaliwal’s brilliant article about good role models for effective clinical reasoning is a must-read. Dr. Dhaliwal points out that Gregory House has obvious limits as a diagnostician one would want aspiring doctors to emulate. This probably has something to do with the fact that he is: 1) addicted to opiates; 2) an asshole; 3) a shoot-from-the-hip utilizer of invasive risky tests; and 4) an abusive mentor.

However, Dr. Dhaliwal suggests that two expert diagnosticians have been on the media every week for the last 31 years.  Every week they solve diagnositc puzzle in a way that displays “many of the ACGME core competencies”.

These mavens of diagnostic acumen are Click and Clack, The Car Talk guys, AKA Tom and Ray Magliozzi.

As Dhaliwal explains, with every caller the brothers demonstrate key elements of clinical reasoning:

1. Building rapport
2. Hypothesis generation and selection
3. Solution-driven questions
4. Problem representation
5. Problem-solving strategies
6. Second opinions
7. Quality improvement
8. Good-natured humor

This is a great short read.
Thanks to the “Wachter’s World“, an essential blog that highlighted this article I had missed when it first appeared several months ago. Wachter’s related post is also well worth reading.