Complexities of the Diagnostic Process

The diagnostic process is a highly complex, problem-solving enterprise. Yet, traditional case reports have not focused directly on this endeavor. Physicians could use the case format to present actual experiences of getting to a diagnosis. This approach would allow for modeling of nonjudgmental, self-reflective practices and also provide information to aid in studying the diagnostic endeavor. Given that diagnostic errors in medicine are widespread and constitute a serious public health problem, it is crucial for physicians to understand the diagnostic process as one step toward improving error rates. This article uses clinical examples to illustrate and discuss the numerous areas of competence that are involved in coming to a diagnosis. The dual-process cognition model for understanding diagnostic decision making is introduced; the role of creativity is emphasized. Psychiatrists have important contributions to make in understanding the diagnostic process, given the field's long history of valuing self-reflection and conceptualizing clinician-patient dynamics.