[Diagnostic reasoning in patients with multimorbidity].

Area of Science:

• Medical diagnostics
• Clinical reasoning
• Multimorbidity research

Background:

• Patients with multimorbidity often present complex interactions between diseases.
• Existing diagnostic guidelines are primarily designed for single diseases and are not well-suited for multimorbidity.
• This mismatch can lead to diagnostic burden and incidental findings without clinical utility.

Purpose of the Study:

• To propose an expanded diagnostic reasoning framework for patients with multimorbidity.
• To emphasize a goal-oriented assessment that prioritizes the progression of existing conditions.
• To advocate for shared decision-making regarding diagnostic investigations, focusing on therapeutic value.

Main Methods:

• Review of current diagnostic reasoning limitations in multimorbidity.
• Conceptualization of a multimorbidity-targeted diagnostic approach.
• Introduction of tools like causal loop diagrams to visualize disease interactions.

Main Results:

• Disease interactions (random, causal, synergistic) complicate diagnosis in multimorbidity.
• A multimorbidity-focused diagnostic strategy is needed, prioritizing existing disease progression over new disease work-up.
• Shared decision-making should ensure diagnostic tests offer clear therapeutic benefits.

Conclusions:

• Diagnostic reasoning must adapt to the complexities of multimorbidity.
• A goal-oriented, multimorbidity-centered approach can enhance diagnostic efficiency and patient outcomes.
• Tools visualizing disease interactions can support this revised diagnostic paradigm.