This resource was originally created by GP Synergy with the support of the Australian Commonwealth Government under the AGPT Program, and has been adapted to an online version by General Practice Supervision Australia (GPSA) under Intellectual Property rights granted thereto in January 2023.
There are multiple approaches to diagnostic reasoning.
Randomly selecting a model avoids the temptation to fall back on a favoured approach.
The aim of this game is to explore different styles of thinking, and to find potential blind-spots or biases in your thinking. This is best done by giving a full effort to using the randomly-selected Reasoning Model, even if this is difficult.
To refresh the cards and ensure you are always randomly selecting the next one, use the 2-way arrow beneath the deck before clicking on the facing card.
It is possible to draw a combination of cards which do not make sense, usually due to a clash of the age or gender of the patient with a presenting complaint or observations.
For example:
Demographics: 6 week-old male
Presenting complaint: Fevers
Initial observation: Talking in short sentences
If this happens, you can either consider a more appropriate similar presentation for the duration of the game e.g. consider “talking in short sentences” to mean “respiratory distress,” and proceed on this basis, or discard that card and draw another by clicking on the 2-way arrow icon beneath the card.
Consider the body anatomically, starting with the head, and think about any pathology of that particular structure which could explain the information shown on the cards.
This reasoning model uses a mnemonic to prompt the clinician through a list of possible causes or types of conditions in an effort to aid recall of known diagnoses:
V – Vascular
I – Infectious or Inflammatory
N – Neoplastic
D – Drugs or Degenerative
I – Intoxication or Idiopathic
C – Congenital
A – Autoimmune or Allergic
T – Trauma
E – Endocrine
M – Metabolic or Mental
Also known as Murtagh’s Model, PROMPT follows a series of logical steps in considering a differential:
A. What is the probability diagnosis (what is most likely)?
B. What serious conditions must be ruled out?
C. What conditions are often missed?
D. Consider the seven masquerades (conditions which can be difficult to diagnose because of their many possible presentations):
1. Depression
2. Diabetes
3. Drugs
4. Anaemia
5. Thyroid dysfunction
6. Spinal dysfunction
7. Urinary tract infection
E. Is this patient trying to tell me something?
This model relies heavily on pattern recognition, or ‘illness scripts’. The clinician spots patterns in the information available which resemble the known patterns of particular conditions.
Similar to the Anatomic Model, but in this case work through the major body systems (cardiovascular, respiratory etc), considering whether there is a condition affecting each system which would explain the clinical features.
The most complex of the reasoning models, ‘pivot and cluster’ relies on identifying the patterns within the data, and then considering if there are any other possible diagnoses which have the same pattern. For example, if the patient presents with fever and right iliac fossa pain, a possible diagnosis is appendicitis. This is your pivot.
Now, consider other things which follow the same pattern: for example, pelvic inflammatory disease, or diverticulitis. This is the cluster.
Consider whether any of the possible diagnoses in the cluster is more or less likely. If one is considered more likely, it becomes the new pivot.
Date reviewed: 13 September 2023
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