[Clinical decision-making: from diagnosis to prognosis-oriented approach].

Medical practice has long relied on diagnosis as the foundation for treatment planning. This approach assumes that identifying the cause of symptoms leads to effective interventions. However, not all patients benefit equally from this model. Some conditions lack effective treatments, and others remain undiagnosed despite thorough evaluation. In these cases, diagnostic clarity does not guarantee favorable outcomes. Prior research has shown that outcomes depend on factors beyond diagnosis, such as patient-specific biological traits and social determinants. This gap motivated the exploration of alternative frameworks for clinical reasoning. That uncertainty drove the need to shift focus from diagnosis to prognosis. No prior work had resolved how to integrate prognosis into decision-making systematically. This paper addresses that need by proposing a new approach.

The study aims to challenge the traditional diagnosis-based model of clinical decision-making. It seeks to highlight limitations in relying solely on diagnosis for treatment planning. The authors aim to introduce a prognosis-oriented framework as a more comprehensive alternative. This approach considers multiple factors influencing patient outcomes. The motivation stems from the recognition that diagnostic certainty does not always equate to effective care. The study also aims to provide a practical model for clinicians to adopt. It emphasizes the importance of identifying modifiable factors affecting prognosis. The goal is to improve clinical reasoning and patient outcomes through this shift.

The authors conducted a conceptual analysis of clinical decision-making paradigms. They reviewed existing literature on diagnosis and prognosis in medical practice. The approach is based on synthesizing evidence from clinical and social sciences. The framework was developed through iterative discussions among experts in internal medicine. No primary data collection was performed; instead, the focus was on theoretical modeling. The model integrates biological, clinical, and social factors into a unified framework. The authors propose a three-question model for clinical reasoning. This method emphasizes identifying and addressing factors influencing prognosis.

The authors found that diagnosis alone is insufficient for guiding treatment in many clinical scenarios. Patients without a diagnosis or with untreatable conditions often require alternative approaches. The prognosis-oriented model incorporates biological, clinical, and social variables. This model allows clinicians to identify factors that may influence future outcomes. The three-question framework helps guide decision-making beyond diagnosis. The model emphasizes actionable factors that can be addressed to improve outcomes. It provides a structured approach to clinical reasoning focused on patient-specific variables. The authors suggest this model improves the relevance of clinical decisions to patient outcomes.

The authors conclude that a prognosis-oriented approach offers a valuable alternative to traditional diagnosis-based decision-making. This model allows clinicians to consider factors beyond diagnosis when planning care. The three-question framework provides a practical tool for integrating prognosis into clinical reasoning. The approach is particularly useful for patients without a clear diagnosis or effective treatment. The model emphasizes identifying and addressing modifiable factors influencing outcomes. The authors propose that this shift improves clinical decision-making relevance and effectiveness. It allows for more personalized and outcome-focused care strategies. The study suggests that this model complements rather than replaces traditional diagnostic approaches.