Illustration of Teaching Cognitive Processes

Edward Winslow edbjwinslow at GMAIL.COM
Wed Sep 14 18:05:26 UTC 2016

Thanks for the articles, David.
As Detsky says, most often students are "too confident" and have difficulty
incorporating uncertainty into their thought processes, and always look at
the bottom of the lake. If we tell this story too many times on rounds,
we'll become branded as "The snakes on the dock, Doc."

Maybe we could challenge ourselves to teach our teachers some aspects of
story telling. We all might need a series of anecdotes about how things
like unanticipated consequences of things that we do should change our
approach to patient care.
Maybe we could collect a series of anecdotes/stories that will help us
explain why things like constructing a differential diagnosis could be

I heard a story yesterday:
A fairly prominent citizen of Chicago got care from 3 different sources (an
AMC, a prominent Orthopaedic group, and another well known hospital in the
area). At the first two, he had surgery on his foot and ankle. About 10
days later he was evaluated at the third hospital for back pain with
sciatica. The neurosurgeon gave him Dexamethasone and was horrified when
the patient developed an infection at the site of the prior surgery,
complicated by sepsis. When I asked the citizen, whether anyone did a
"complete" exam, including looking at the feet and legs, he didn't remember
that happening. This wasn't a failure of the three different EMRs that
didn't talk to each other (would an HIE have helped - maybe), but it WAS a
failure of doing enough to ensure that a diagnosis wasn't missed. Maybe a
medical student having to do a "complete H&P" might have helped this

Detsky does tell us several stories about not looking one place only, but
trying to keep our minds open to other possibilities. Can we find more?

On Wed, Sep 14, 2016 at 10:29 AM, David Katz <d.katz at>

> Hi all,
> One of my mentors, Allan Detsky, has written a really nice illustrative
> piece in JAMA about teaching cognitive processes.
> Enjoy,
> David Katz
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*Edward B, J. Winslow, MD, MBA*
Home 847 256-2475; Mobile 847 508-1442
edbjwinslow at

"The only thing new in the world is the history that you don't know"
       Harry S. Truman, 33rd President of US (1945-1953)

"... it can be argued that underinvestment in assessing the past is likely
lead to faulty estimates and erroneous prescriptions for future action."
        Eli Ginzberg, 1997

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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