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This chapter provides a detailed guide to clinical reasoning, assessment, and plan development for healthcare professionals. It covers the dual processing theory, steps of clinical reasoning, illness scripts, semantic qualifiers, problem representation, hypothesis generation, common diagnostic errors, strategies to avoid errors, and documentation practices. The chapter emphasizes the importance of systematic thinking, evidence-based decision-making, and patient-centered care.
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Chapter 5: Clinical Reasoning, Assessment, and Plan This chapter guides clinicians through the systematic process of clinical reasoning, including the development of differential diagnoses, constructing problem representations, and creating comprehensive assessments and plans. New medical terms are defined in plain English for better understanding. Clinical Reasoning: Process Dual Processing Theory: System 1: Intuitive, fast, automatic decision-making based on heuristics (mental shortcuts). Example: Quickly recognizing classic signs of a common condition. System 2: Analytical, slow, controlled reasoning using logic and evidence. Example: Analyzing complex, atypical cases. Steps of Clinical Reasoning (Box 5-1):
o Prioritize differential diagnoses.
Heuristics: Mental shortcuts used for quick decision-making. Illness Script: A detailed mental model of a specific disease. Semantic Qualifiers: Descriptors used to compare and differentiate diagnoses. Anchoring Bias: Sticking to an initial impression despite new evidence. Framing Effect: Decision influenced by how information is presented. This detailed guide ensures no critical information is omitted, integrating all medical terms, key processes, and illustrative examples for optimal learning.