Operational contemporary diagnostic reasoning
Medical and scientific technologies have been pillars of this progress. However, as with every powerful tool, recently there have been caveats to modulate their judicious use as well as their clinical implications.
Complex data gathering, as it occurs in medical history, may not be properly dealt with when there are time constraints–not to mention the human dimension of the clinical encounter. Patients' narratives provide the necessary and sometimes unique data necessary for medical diagnosis and therapeutic decisions. They also carry other dimensions of the human condition–suffering, fear, alarm, anxiety, apprehension, etc.–among the many needs involved in such interactions.
A recent study demonstrated an inverse relationship of patient satisfaction with computer use: patients in a clinical encounter with high computer use were less likely to rate care as excellent (12 of 25 [48%] vs. 16 of 19 [83%] patients; p = 0.04).
The way patients are listened to (quality) and the dedicated time spent with them (quantity) are expected to be efficiently combined.
In addition to economic costs and time wasting by patients submitted to unnecessary testing, there may be other consequences.
Jargon that is frequently used in medical reports may make patients worried about their meaning when they read it. Many patients go to the internet and become more anxious about their condition.
Other effects are related to comments about the findings of the examination being performed made by the operator during the procedure (mainly when the operator is a physician)
In addition to the costs of a specific test, the effects associated with downstream testing were reported, such as further testing or invasive procedures. Interestingly, in exercise treadmill testing, symptoms, when present, were more important than the results of the testing; inconclusive results were the reason for further testing in 63% of the patients.
Some tests were listed as “not reflecting high quality care.” A test should not be performed if there is a low pre-test probability of disease, if the result will not change the management of the condition, and if there is a risk of downstream costs of new tests.
Recently, the increase in exposure to radiation of some tests (computed tomography, magnetic resonance imaging, nuclear medicine, and positron emission tomography) has been recognized.
In conclusion, medical practice in a time of exploding knowledge gives rise to the opportunities of further reassessing diagnostic reasoning, including time and heuristic issues, in an updated clinical epistemology to avoid the risk of superficial reasoning due to methodological shortage.