1. What am I observing?

• Describe it. Name it, if possible.
• Summary statement: One or no more than two sentences. (Problem representation)
• Use of semantic qualifiers. (Facilitates pattern recognition)

2. What is my initial problem list?

• Defining the whole context (Problem representation)

3. What is my primary diagnosis?

• Use of illness scripts
• Is all the information concordant, or is there discordant information? (Diagnostic verification; diagnostic coherence and adequacy, avoid search satisficing.)
• What is the estimated prevalence of the disease and is there a more common diagnosis that I should consider? (Probabilistic reasoning; avoid base rate neglect.)

4. Does my diagnosis fit the physiology I am observing?

• Casual Reasoning: Use of Inductive reasoning to infer causality, i.e. the relationship between cause (the pathophysiology) and effect (the observed physiology)
• To confirm your diagnosis suggested from an illness script or to infer a diagnosis when you don't have an illness script that fits the presentation, use physiologic based reasoning.

5. What is my differential diagnosis?

• What else could it be?
• Always consider the alternatives. (Cognitive forcing function to avoid premature closure, representativeness restraint, anchoring, availability, confirmation, or framing biases.)
• Is there a "must-not-miss" diagnosis that I need to consider?

6. What tests do I need to order, if any?

• What specific question am I asking with the test?
• Do I need to know the answer?
  • Will it affect my diagnosis? (Post-test hypothesis refinement)
  • Will it affect patient management or patient outcome?
• Do I already know the answer?
• Is this the right time to ask the question?

7. Will the test answer the question?

• What is the sensitivity and specificity of the test?
• What is the pretest probability of the disease? (Pretest and conditional probabilities, likelihood ratios.)
• What is the error rate of the test? (Post-test probability)

8. Are there any alternative tests that are more appropriate based upon accuracy, risks, degree of discomfort or cost?

In every patient encounter, always know the medications. Always ask yourself:

• "What medication is the patient on?"
• "What medications are they actually taking/getting"
• "What indicated medications are they not on?"
• "What medications are they on that they should not be on?"

1. What am I observing?

• Describe it. Name it, if possible.
• Summary statement: One or no more than two sentences. (Problem representation)
• Use of semantic qualifiers. (Facilitates pattern recognition)

2. What is my initial problem list?

• Defining the whole context (Problem representation)

3. What is my primary diagnosis?

• Use of illness scripts
• Is all the information concordant, or is there discordant information? (Diagnostic verification; diagnostic coherence and adequacy, avoid search satisficing.)
• What is the estimated prevalence of the disease and is there a more common diagnosis that I should consider? (Probabilistic reasoning; avoid base rate neglect.)

4. Does my diagnosis fit the physiology I am observing?

• Casual Reasoning: Use of Inductive reasoning to infer causality, i.e. the relationship between cause (the pathophysiology) and effect (the observed physiology)
• To confirm your diagnosis suggested from an illness script or to infer a diagnosis when you don't have an illness script that fits the presentation, use physiologic based reasoning.

5. What is my differential diagnosis?

• What else could it be?
• Always consider the alternatives. (Cognitive forcing function to avoid premature closure, representativeness restraint, anchoring, availability, confirmation, or framing biases.)
• Is there a "must-not-miss" diagnosis that I need to consider?

6. What tests do I need to order, if any?

• What specific question am I asking with the test?
• Do I need to know the answer?
  • Will it affect my diagnosis? (Post-test hypothesis refinement)
  • Will it affect patient management or patient outcome?
• Do I already know the answer?
• Is this the right time to ask the question?

7. Will the test answer the question?

• What is the sensitivity and specificity of the test?
• What is the pretest probability of the disease? (Pretest and conditional probabilities, likelihood ratios.)
• What is the error rate of the test? (Post-test probability)

8. Are there any alternative tests that are more appropriate based upon accuracy, risks, degree of discomfort or cost?

In every patient encounter, always know the medications. Always ask yourself:

• "What medication is the patient on?"
• "What medications are they actually taking/getting"
• "What indicated medications are they not on?"
• "What medications are they on that they should not be on?"