Logical Approach to Clinical Reasoning

What is type I clinical reasoning?

pattern-recognition: develop a list of illness scripts

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What is type II clinical reasoning?

Problem based solving via analytical reasoning

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When does type I clinical reasoning work best?

- works for common diseases with typical presentations
- when there are only a few possibilities to remember
- possibilities can be easily ruled in/out by diagnostics
- when clinical pattern for disease is unique

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Pros of type I clinical reaosning?

- doesn't need to be taught
- quick (if correct)
- cost effective (if correct)

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Cons of type I clinical reasoning?

- needs limited #options
- doesn't work for atypical presentations
- difficult for uncommon disorders
- dependent on previous Dx and clinical signs matching
- depends on experience, memory
-risk tunnel vision
- risk confirmation bias
- no clear alternate

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What is type II analytical reasoning?

Logical clinical problem solving (LCPS)

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When to use LCPS?

- inexperience
- uncommon disorder
- atypical disease presentations
- safety check for pattern recognition

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Steps to LCPS?

1) Define the problem
2) Define system (and how involved)
3) Define Location
4) Define the lesion

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Why should you make a problem list?

- makes clinical signs explicit
- makes vague specific
- prevent overlooking less obvious but crucial clinical signs
- clarify any difference in chronology of signs
- allows possibility of multiple disorders

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What do you do to define the system?

1) major body system
2) primary or secondary
3) Local or systemic

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What is a primary problem?

pathology is in that system e.g. neoplasm, infection, inflammation

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What is secondary problem?

Pathology outside the system is affecting the way the system is functioning e.g. affects of hypoxia, electrolyte changes, toxins on organs.

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How do you differentiate treatment of structural and functional primary disease?

Surgical treatment = structural
Medical treatment = functional

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What happens if incorrect definition of problem or system?

- endangering patient by delaying or incorrect diagnosis
- wasted time
- wasted money
- impaired client-vet trust

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When defining the lesion, what acronym can help you?

DAMNIT

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What does DAMNIT stand for?

- Degenerate / Developmental
- Anomalous/ Autoimmune
- Metabolic / Mechanical/ Mental
- Nutritional/ Neoplasia
- Inflammatory/ Infection/ Ischemic/ Immune/ Inherited/ Iatrogenic/ Idiopathic
- Traumatic

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Description of Degenerate Disease?

Gets worse over time, or with ageing.

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Description of developmental disease?

Congenital: hypoplasia of organs, anagenesis etc

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Examples of Metabolic Disease?

Hormone imbalances, enzyme deficiencies etc

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Examples of mechanical disease?

pressure, thermal injury, ionising radiation

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Description of mental disease?

pyschological, behavioural

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2 types of Neoplasm?

Benign neoplasms, malignant neoplasm (non-metastatic versus metastatic)

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Differentials prioritised via?

species
age
breed
sex
geographic location
History

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Pros of LCPS?

- avoid confirmation bias
- avoid tunnel vision
- helps chunk differentials
- ensures appropriate history taken

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What MUST you do with LCPS?

Must ensure full and transparent communication with owners about appropriate diagnostics and treatment required

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Logical Approach to Clinical Reasoning

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