Being better clinicians: an acronym to excellence

Teaching clinical medicine: the key principals

BACKGROUND

Many studies analyse the diagnostic process, diagnostic errors and diagnostic excellence but few provide a broad, yet practical view of this complex and highly context-dependent challenge.

METHODS

A personal, experience- and research-based selection of the principles of data collection, processing and clinical reasoning found to be most useful in achieving an efficient, timely and patient-centered diagnosis.

RESULTS

Twenty-four principles were identified and each one is presented followed by a brief commentary.

CONCLUSIONS

No single strategy can provide a solution for all diagnostic problems. However, the 24 principles have proven validity and can be applied for solving diagnostic problems in varied settings and as a scaffold in teaching diagnosis at all levels of medical education.

The clinical encounter revisited

The patient-physician encounter is the pivotal starting point of any healthcare delivery, but it is subject to multiple process breakdowns and prevalent suboptimal performance. An overview of the techniques and components of a successful encounter valid for every setting and readily applicable is presented, stressing 7 rules: (1) ensuring optimal environment, tools, and teamwork; (2) viewing each encounter not only as a cognitive/biomedical challenge, but also as a personal one, and a learning opportunity; (3) adopting an attitude of curiosity, concentration, compassion, and commitment, and maintaining a systematic, orderly approach; (4) "simple is beautiful"-making the most of the basic clinical data and their many unique advantages; (5) minding "the silent dimension"-being attentive to the patient's identity and emotions; (6) following the "Holy Trinity" of gathering all information, consulting databases/colleagues, and tailoring gained knowledge to the individual patient; and (7) using the encounter as a "window of opportunity" to further the patient's health-not just the major problem, by addressing screening and prevention; promoting health literacy and shared decision-making; and establishing proper follow-up. Barriers to implementation identified can be overcome by continuous educational interventions. A high-quality encounter sets a virtuous cycle of patient-provider interaction and results in increasing satisfaction, adherence, and improved health outcomes.