Diagnostic Reasoning: An Endangered Competency in Internal Medicine Training

Tom Benzoni benzonit at GMAIL.COM
Tue Sep 12 15:34:56 UTC 2017

> This article holds an example of the gap between "saying" and "doing."
> Residents are being taught to think/reason through a problem before picking
> up the pen/mouse. The wake up will happen when they step outside academia.

> As a society, we SAY we value diagnostic reasoning so that we don't have
> to PAY for it.
> We pay for what we value; we value CT scans because that's what we pay for.

> I teach clinical reasoning to my students, but when they get in the field,
> their non-medical bosses want them to order tests. This pressure to order
> tests instead of thinking is done by paying on productivity. (I keep a
> clinical practice, too, and am paid 40% by time, 60% by RVU's generated.)
> (If you're (plural) unfamiliar with the concept, say so and I'll generate a
> thread. If you're familiar with the concept, weigh in. If you only think
> you're familiar with the concept, congratulations for the honesty; you've
> started the journey.)
> tom
> On Mon, Sep 11, 2017 at 11:36 PM, HM Epstein <hmepstein at gmail.com> wrote:
>> This may be a terrific article...if only I could read it. I don't have
>> access to the Annals of Internal Medicine. I've requested Media credentials
>> but in the meantime, for those of you who do have access, here's an
>> abstract. And the link: http://annals.org/aim/ar
>> ticle/2653703/diagnostic-reasoning-endangered-competency-
>> internal-medicine-training
>> Best,
>> Helene

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

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