Thursday, September 13, 2018

Heuristic principles

Akbar MOHAMED Chettali

Consultant Paediatric Neurologist/ Lead Director Aster KIND - Kids Integrated Neuro Development Unit/ Deductive Clinician with expertise for Rare Disease/ Mind Consultant, Coach, Mentor and Teacher

A clinician needs to follow certain rules to improve his skills

Diagnostic errors happen due to certain common mistakes

Some common ones are

1. Premature closure —- coming quickly to conclusion

2. Faulty triggering — due to faulty information gathering and poor history taking / poor      
    interpretation of  tests

3. Faulty estimation of probability —- Occam Razor concept

Common things are always common

4. Failure to identify a pattern of disease and failure to anticipate natural course of a disease—     
    known as Gestalt  recognition

5. Over reliance on investigations

Diagnosis can be improved if we follow fisher rules

1. At least three out of five features of a disease should be met to confidently say the diagnosis

2. Always keep an open mind and list differential diagnosis

3. Be vigilant—- symptoms can evolve

4. Be like a police dog —- take a very detailed history and perform good examination/ think you
    are a detective in crime scene

5. Most important—- maintain interest in your patients

These were some concepts I learnt and inculcated during my practice

Thanks to my Patients my Teachers from PGI and AIIMS

Happy Teachers Day



From LinkedIn

Caplan LR. Fisher's Rules. Arch Neurol. 1982 Jul;39(7):389-90.

1.   The bedside can be your laboratory.  Study the patient seriously.

2 .  Settle an issue as it arises at the bedside.

3.   Make a hypothesis and then try as hard as you can to disprove it or find the    
      exception before accepting it as valid.

4 .  Always be working on one or more projects; it will make the daily routine more meaningful.

5.   In arriving at a clinical diagnosis, think of the five most common findings   
      physical findings or laboratory) found in a given disorder.
6.   Describe quantitatively and precisely.

7.   The details of the case are important; their analysis distinguishes the expert from the

8.   Collect and categorize phenomena; their mechanism and meaning may become clearer        
      later if enough cases are gathered.

 9.   Fully accept what you have heard or read only when you have verified it yourself.

10.  Learn from your own past experience and that of others (literature and experienced

11.  Didactic talks benefit most the lecturer. We teach others best by listening, questioning           
       and demonstrating.

12.  Write often and carefully. Let others gain from your work and ideas.

13.  Pay particular attention to the specifics of the patient with a known diagnosis; it will    
       be helpful later when similar phenomena occur in an unknown case.                

14.  Be a good listener; even from the mouths of beginners may come wisdom.

15.  Resist the temptation to prematurely place a case or disorder into a diagnostic cubbyhole
       that fits poorly.

16.  The patient is always doing the best he can.

17.  Maintain a lively interest in patients as people.

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