Page 17 - Demo

Highlights of EAP 202317Diagnostic Process: Tips to Navigate Clinical ConundrumsA diagnosis is a hypothesis about the nature of a patient%u2019s illness based on observations, evidence, and reasoning. Physicians aim to reduce the level of diagnostic uncertainty enough to make optimal therapeutic decisions. The diagnostic process is a complex, patientcentered, and collaborative activity that involves information gathering and clinical reasoning. However, the diagnostic process is often complicated by several uncertainties pointing to competing diagnoses. In this talk, Dr. Silvia Bressan examined the theoretical and practical aspects diagnostic process and suggested tips to navigate clinical conundrums successfully in the setting of pediatric emergencies. Dr. Bressan highlighted that developing %u201cclinical reasoning%u201d skills among clinicians through training is a fundamental requirement for enhancing their diagnostic capabilities (Figure 1). The development of clinical reasoning includes critical thinking skills such as analysis, evidence evaluation, and interpretation. In addition, opportunities to improve clinical reasoning include instruction and practice on how to develop and refine a differential diagnosis and a focus on developing probabilistic reasoning skills. Another crucial skill to be developed is %u201cBayesian reasoning,%u201d which involves assessing the probability that a patient has a disease, given the presence/absence of this symptom/sign or test result.Next, Dr. Bressan pointed out that the diagnostic process is not a solitary physician-related activity as it involves several team members. Therefore, teamwork and effective communication are essential ingredients in developing diagnostic excellence. Moreover, in the emergency setting, time is crucial, and it runs out fast. Therefore, it is essential not to forget the value of time. Given the scarcity of time in the emergency setting, clinicians can resort to using memory aids, decision aids, and clinical prediction tools. Importantly, practitioners must learn from feedback, experience, and diagnostic errors to improve their diagnostic process. Lastly, they must make all efforts to limit the effect of cognitive bias. Dr. Bressan concluded that there is no perfect recipe to resolve conundrums arising during the diagnostic process. However, some ingredients/tips to aim for the best results include strengthening clinical reasoning skills, teamwork, effective communication, valuing time, safety-netting, feedback & learning from diagnostic errors, and improving awareness of bias which may affect the diagnostic process. Silvia Bressan Pediatric Emergency Physician & Assistant ProfessorUniversity of PadovaItalyFigure 1: Example of a training system to enhance clinical reasoning.Presenter