Tags: clinical reasoning
Problem representation in clinical diagnostic reasoning is the process of understanding and summarizing the patient's clinical problem in a way that is relevant and useful for generating and evaluating diagnostic hypotheses. It is a critical step in the diagnostic reasoning process, as it helps clinicians to focus their attention on the most important information and to avoid getting sidetracked by irrelevant details.
A good problem representation should be:
Accurate: It should accurately reflect the patient's clinical presentation, including all of the relevant history, physical examination findings, and laboratory results.
Concise: It should be concise enough to be easily remembered and used, but it should also be complete enough to provide a good foundation for generating and evaluating diagnostic hypotheses.
Specific: It should be specific enough to guide the clinician towards the most likely diagnoses, but it should also be flexible enough to allow for new information to be integrated as it becomes available.
There are a number of different ways that clinicians can develop a problem representation. One common approach is to use a problem statement format. This involves summarizing the patient's clinical problem in a single sentence or short paragraph that highlights the key findings and the most important questions to be answered. Another approach is to use a problem list. This involves listing the patient's individual clinical problems, along with any relevant information about each problem.
Once a problem representation has been developed, it can be used to guide the clinician through the rest of the diagnostic reasoning process. For example, the clinician can use the problem representation to generate a differential diagnosis, to order appropriate diagnostic tests, and to interpret the results of those tests. The problem representation can also be used to develop a treatment plan and to communicate with other members of the healthcare team.
Here is an example of a problem representation for a patient with chest pain:
Problem statement: A 55-year-old male with a history of hypertension and dyslipidemia presents with acute, retrosternal chest pain that is radiating to his left arm. The pain is described as sharp and stabbing, and it is aggravated by exertion. The patient has no other significant medical history.
Problem list:
Acute chest pain
Hypertension
Dyslipidemia
This problem representation is accurate, concise, and specific. It accurately reflects the patient's clinical presentation, and it is specific enough to guide the clinician towards the most likely diagnoses (e.g., acute coronary syndrome, pulmonary embolism).
Problem representation is an essential skill for clinicians of all levels of experience. By developing a good problem representation, clinicians can improve their diagnostic accuracy and efficiency, and they can provide better care for their patients.
Bowen, J.L. and Olle ten Cate (2017). Prerequisites for Learning Clinical Reasoning. Innovation and change in professional education, [online] pp.47–63. doi:https://doi.org/10.1007/978-3-319-64828-6_4.
Bansal, A. (2022). Problem Representation. [online] The Clinical Problem Solvers. Available at: https://clinicalproblemsolving.com/2022/06/12/problem-representation. [Accessed 11 Oct. 2023].