1. Novice medical practitioners tend to use a "shotgun" approach to testing without a clear target in mind, while experts usually have a specific target and tailor their testing strategy accordingly. 2. Developing diagnostic virtuosity requires strong clinical reasoning abilities, medical knowledge, pattern recognition skills, and the ability to effectively integrate various information sources. 3. Effective communication and collaboration with patients and other medical professionals is also important for making accurate diagnoses and treatment decisions.

1. How to Make a Diagnosis
And
Provide Care?
施相宏 主任
高醫 兒童一般科

2. Harrison’s Principles of Internal Medicine, 18ed
• 初學者
– A novice medical practitioner typically uses a
"shotgun" approach to testing, hoping to hit a
target without knowing exactly what that target is.
• 專家
– The expert, in contrast, usually has a specific
target in mind and adjusts the testing strategy to it.

3. 診斷技藝 Diagnostic Virtuosity
• 1. Cognitive dimensions (clinical reasoning)
– Medical knowledge (ACGME core competencies)
– Patterns of clinical problems
– Pathophysiological “Flow chart”
– Impression vs. Differential diagnosis
– “Scientifically sound”

4. 診斷技藝 Diagnostic Virtuosity
• 2. integration of verbal (history taking) and
visual cues (inspection) or information
• 3. motor and interpretation skills that are
required in the performance of various
invasive and noninvasive procedures and tests
• 4. communicate effectively with patients and
work effectively with members of the medical
team

5. Decision Making
• "actions" in clinical medicine are not
procedures or prescriptions but the judgments
(both diagnoses and treatment decision
making)

6. Intuitive versus Analytic Reasoning
• Novices vs. Experts
• pattern recognition: stored repertoire of
diagnostic patterns
• heuristics 直覺式、啟發式思考
– Greek 'heuriskein ' meaning 'to discover'
• “analytic approach” (logical thinking) +
intensive data collection (EBM)

7. Harrison’s Principles of Internal Medicine, 18ed
• Evidence-based medicine (EBM) is the term
used to describe the integration of the best
available research evidence with clinical
judgment and experience as applied to the
care of individual patients.

8. ACGME 六大核心能力
• 獨立、第一線提供照護 (primary care)
• 協同照護及指導者
• 醫學專業知識（medical knowledge）
• 臨床推理與決策
• 人際溝通與互動能力
• 敘事醫學 (同理心、家庭文化與社會背景)
• 臨床醫學倫理 = How you ACT?