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Healthy Skepticism Library item: 20390

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Schmidt HG, Norman GR, Boshuizen HP.
A cognitive perspective on medical expertise: theory and implication.
Acad Med 1990; 65:(10):611-21
http://pt.wkhealth.com/pt/re/lwwgateway/landingpage.htm;jsessionid=Q20ZpzJhktQPhgT1zJYgbyXTg90kPXkLl1s4J8xWn8lFZBjZVjf2!755119086!181195629!8091!-1?issn=1040-2446&volume=65&issue=10&spage=611


Abstract:

A new theory of the development of expertise in medicine is outlined. Contrary to existing views, this theory assumes that expertise is not so much a matter of superior reasoning skills or in-depth knowledge of pathophysiological states as it is based on cognitive structures that describe the features of prototypical or even actual patients. These cognitive structures, referred to as “illness scripts,” contain relatively little knowledge about pathophysiological causes of symptoms and complaints but a wealth of clinically relevant information about disease, its consequences, and the context under which illness develops. By contrast, intermediate-level students without clinical experience typically use pathophysiological, causal models of disease when solving problems. The authors review evidence supporting the theory and discuss its implications for the understanding of five phenomena extensively documented in the clinical-reasoning literature: (1) content specificity in diagnostic performance; (2) typical differences in data-gathering techniques between medical students and physicians; (3) difficulties involved in setting standards; (4) a decline in performance on certain measures of clinical reasoning with increasing expertise; and (5) a paradoxical association between errors and longer response times in visual diagnosis.

Keywords:
Clinical Competence* Clinical Protocols Diagnosis Diagnostic Errors Humans Memory Mental Processes* Physicians/psychology* Problem Solving Quality of Health Care Students, Medical/psychology* Teaching

 

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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963