- Identification of key clinical data
- Semantic competence (the use of precise medical language important in ‘chunking’ information in to larger units which helps to organise and store information)
- Synthesising data in to problems (or ‘problem representation’)
- Making relevant associations between problems
- Critical thinking – for example, spotting and avoiding assumptions
- Formulation of a management plan that takes all the patient’s problems in to account
The ability to identify key clinical data and create a problem list using precise medical terms is a key step in clinical reasoning development. Some problems (e.g. low serum potassium) require action but not necessarily a differential diagnosis. Other problems (e.g. vomiting) do require a differential diagnosis. The process of generating a problem list ensures nothing is missed. It also ensures the plan is sound - if a person with pleuritic chest pain needs a CT scan to exclude a pulmonary embolism but their creatinine is too high to safely administer contrast, the plan has to take that into account.
Teach problem lists not differential diagnosis.