Educational strategies to promote clinical diagnostic reasoning.N Engl J Med. Thirty years of illness scripts: Theoretical origins and practical applications.Med Teach. ReferencesĬharlin B, Boshuizen HP, Custers EJ, Feltovich PJ. Diseases encountered less frequently will have less robust scripts. This iterative process continued throughout a clinician’s career, adds depth, precision and differentiating power to the foundational scripts developed during training (5).
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They emphasize distinguishing characteristics whose presence or absence significantly alters the likelihood of the diagnosis, and helps differentiate it from another related diagnosis. Example: A lobar infiltrate on chest x-ray without cardiomegaly or cephalization of vessels is highly suggestive of CAP and makes congestive heart failure less likely.They encode a predictive value for each feature of the disease, enabling them to estimate the likelihood of a diagnosis when that feature is present or absent. Example: The absence of a fever does not exclude the diagnosis of community acquired pneumonia (CAP) in an elderly patient.With experience, providers hone their illness scripts in three important ways (5): Post upper respiratory tract viral infectionĪntibiotics typically lead to improvement over days.Most commonly caused by Streptococcus pneumoniae.Infection of the lower respiratory tract.
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For example, a provider’s illness script for community acquired pneumonia (CAP) may include: Classically, the components of a thorough illness script fall into three main categories: “the predisposing conditions, the pathophysiological insult, and the clinical consequences (4).” Within these categories, illness scripts often include a disease's pathophysiology, epidemiology, time course, salient symptoms and signs, diagnostics, and treatment. It represents a clinician's knowledge about a particular disease, and may be as short as a 3x5 pocket card description for a rare disease, or as long as a book chapter for a commonly encountered illness. An illness script is an organized mental summary of a provider’s knowledge of a disease (1-3).