A Reflective Verbalization Strategy to Trigger Alternative Diagnostic Hypotheses

Physicians sometimes encounter various types of gut feelings (GFs) during clinical diagnosis. The type of GF addressed in this paper refers to the intuitive sense that the generated hypothesis might be incorrect. An appropriate diagnosis cannot be obtained unless these GFs are articulated and inventive solutions are devised. Thus, the method of articulating GFs is critical.

The current study proposes reflective verbalization (RV) to help healthcare professionals capitalize on their GF. In cognitive psychology, RV is the process of verbalizing one's thoughts and feelings through metacognition, to promote deeper understanding and insight problem-solving. When applied to clinical reasoning, RV can help doctors verbalize their GFs, refining their diagnostic hypotheses.

To address GFs systematically using RV, we introduce the DATES approach, comprising five perspectives: Degree, Abandoned, Time course, Excess, and Shortage. Each perspective prompts physicians to compare their patient's information against typical illness scripts, ensuring no detail is omitted or overlooked.

The tool also aids physicians in considering possible differential diagnoses for one or more of these elements. This guiding tool may aid physicians in overcoming biases, including confirmation and anchoring biases, thus improving diagnostic accuracy. This tool is useful for healthcare professionals who wish to improve their clinical reasoning and decision-making abilities, particularly when they encounter inexplicable contradictions in their diagnostic hypotheses.