Learning to think like a physician – module #2

Understanding system 1 helps us understand the common way experienced physicians approach diagnosis.  But sometimes the patient's problem representation does not fit the physicians "toolbox" of illness scripts.  We each have a collection of illness scripts to match against the problem representation.  But sometimes we cannot easily make a good match.  In those cases we must switch to system 2. System 2 requires thought and a careful consideration of many possibilities.  Descriptors include slow, deliberate, effortful, rule following, and conscious.  When we discuss a patient at morning report, we often delve into a long list of diagnoses, i.e., we construct a differential diagnosis.  We then consider each possible diagnosis and consciously match characteristics of each possibility against the problem representation. I suggest this website as a short introduction to this two system model. What do we do when confronted with a patient?  Early in our career (when we are medical students), we have not built our illness scripts, and therefore we must go to system 2 regularly.  When we teach we often stress system 2 thinking. Interestingly, experts spend more time in system 1.  Expertise involves more refined illness scripts and those illness scripts inform our history taking, our physical examination and our lab testing ordering and interpretation.   The better our toolbox of illness scripts fo...
Source: DB's Medical Rants - Category: Health Medicine and Bioethics Commentators Authors: Tags: Medical Rants Source Type: blogs