Developing Patient-Centred diagnosis as a tool for the new clinical generalist

Talk Code: 
Joanne Reeve, George Freeman, Norbert Donner-Banzhoff
Joanne Reeve, Hull York Medical School George Freeman, Imperial College London Norbert Donner-Banzhoff, Marburg

Diagnosis is exceptionally challenging in primary care. Most serious conditions are rare and most of their symptoms have common and innocuous meanings. Hypothetico-deductive reasoning has become the normative model for clinical practice – applied in primary and secondary care settings despite the differences in epidemiology and presented problems. Drawing on research from clinical reasoning, education and cognitive psychology, Donner-Banzhoff (Ann Fam Med 2018;4:353-358) describes a new model of inductive foraging as an efficient and effective method for clinical practice in the ‘uncertain’ context of primary care. Work that recognises active listening is not just kindness but improves diagnostic yield and efficiency; and that ‘pattern failure’ rather than ‘pattern recognition’ is the dominant mode of discovery in the opening of consultations; rather than the active deductive reasoning commonly taught. A small, but growing body of empirical work highlights a need to look again at diagnostic practice and clinical reasoning – with implications for how we understand professional roles, and train clinicians (both medics and the extended primary healthcare workforce.)


 This workshop will introduce Donner-Banzhoff’s work through a critical discussion that considers the implications for educating primary care clinicians (including the new SAPC-RCGP curriculum); scholarship and professional identity; and the (re)design of primary care services.  The audience will be invited to challenge emerging proposals and so identify the key education, research and scholarship questions and tasks emerging. In the second half of the workshop, participants will work in small groups to develop solutions to the emerging tasks. We will conclude by setting an action plan and timeline for SIG working groups to take this agenda forward.


The session will be useful for educationalists working on training the future workforce; researchers interested in professional practice, clinical decision making, educational research and workforce; and generalist clinicians looking for ideas ‘beyond experience’ to guide them to more effective diagnosis.