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The examination
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
Some parts of the patient examination occur while taking the history. This has been referred to as the ‘eyeball test’ or ‘end-of-bed-o-gram’.6 For example, many non-verbal cues, such as how the patient is sitting, standing or lying, inform the initial assessment. These first impressions help a doctor answer the questions ‘How sick is this patient?’ and ‘How quickly do I need to act?’ An in-depth discussion on making these assessments is beyond the scope of this book. However, we point out that it is ‘system 1 thinking’ that often comes into play here to gain a fast, intuitive impression of a patient.6 The key point is that reflective practice and extensive clinical experience can help doctors to gain more accurate first impressions, although they should always be wary of jumping to conclusions and should review the information collected before making decisions.
Identifying cases of disease: Clinimetrics and diagnosis
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
It is easy to see that jumping to conclusions has a snowball effect: the final diagnosis may ultimately be incorrect, and the patient may be poorly treated. The problem is important not only from a clinical but also from an epidemiological point of view: cases and disease occurrence are poorly assessed, risks and exposures are poorly defined, and incorrect causes can be considered. Epidemiological assessment of interventions may be hampered by an erroneous identification of the frequency of intervention, disease exposure, or other phenomena of interest. Demography or medical geography has at times taken medical information for granted, as if it were solid or ‘written in stone’. This, however, is not always the case. The interface between field epidemiology and clinical epidemiology is also evident for the reasons discussed above.
Psychotherapy
Published in Bhaskar Punukollu, Michael Phelan, Anish Unadkat, MRCPsych Part 1 In a Box, 2019
Bhaskar Punukollu, Michael Phelan, Anish Unadkat
Gain a sense of the person’s experience of their illness:— Onset and duration of symptoms such as voices.— Explore beliefs formed from jumping to conclusions.
Preparing Students for Change: An Advisement Seminar Informed by Tolman and Kremling’s Integrated Model of Student Resistance
Published in Occupational Therapy In Health Care, 2023
Jeni Dulek, Michelle Gorenberg, Kaylinn Hill, Kelsey Walsh, Molly Perkins
Molly: I used what I learned in advising during group work to help me understand the behavior of others in my groups as well as my own. Understanding the importance of proper communication amongst a group in navigating conflicts before jumping to conclusions about other people’s motives was something I got to practice throughout the program. During our second term, a conflict developed between my cohort and an instructor in one of our online courses. When communication with the instructor in addressing our issues failed to lead to a resolution, we turned to our advisors for guidance on the conflict. We were not told what to do but we were able to collectively brainstorm possible actions to take and alternative perspectives to consider. Most of all we felt heard and validated. That process would not have taken place without the opportunity to build a trusting, professional relationship with our advisors throughout first-term advising.
Effects of a behaviour management technique for nursing staff on behavioural problems after acquired brain injury
Published in Neuropsychological Rehabilitation, 2019
Ieke Winkens, Caroline van Heugten, Climmy Pouwels, Anne-Claire Schrijnemaekers, Resi Botteram, Rudolf Ponds
Key items are observation and analysis of the challenging behaviour. Nurses observe the challenging behaviour (by watching the patient, listening to the patient, etc.). To prevent nurses from jumping to conclusions, they are asked to list up all possible internal and external antecedents of the behaviour. There can be many causes of or reasons for the observed problem behaviour. Restless behaviour for example (such as roaming about or repeatedly asking the same question) may have medical causes (e.g., cognitive deficits such as memory or orientation problems, a urinary infection, or known lower back problems), but may also have emotional/psychological causes (such as need for attention, feelings of boredom); and there may be environmental factors (too much light or noise, too few directing stimuli). Apathetic behaviour may have medical causes (a brain injury-related pseudo-depression for example) or psychological/emotional causes (e.g., feelings of unsafety, few positive experiences, too many negative experiences) to name just a few. And last, agitated behaviour may, among other causes, have environmental causes (a new client or employee who talks a lot, sits too close to the patient, etc.)
The Hunt for Non-Barking Dogs and Other Curiosities: Identifying and Managing Anomaly Within Forensic Interviews
Published in International Journal of Forensic Mental Health, 2019
Passives constitute a particularly thorny problem. Forensic practitioners are liable to miss the fact that the speaker is withholding key information: who did the action? To be fair not spotting the unstated is a function of the way we process discourse in everyday life. We delete about half of what is said to us (it is just not registered in working memory), compress, generalize, and go beyond what the speaker has actually said—most commonly by jumping to conclusions (assuming we know what the speaker means) (van Dijk, 1987; van Dijk & Kintsch, 1978). Take, for example, the utterances of a key individual interviewed in a UK murder case (R. v. Paris, Abdullahi and Miller, 1993). She said: The knife was handed to me and I was forced to stab her. As extraordinary as it sounds the interviewing detective failed to note the individual’s sidestepping and did not ask the two vital questions: Who handed you the knife? and Who forced you to stab her? It subsequently emerged that she was never at the murder scene, never saw what happened, and was never materially involved. Because of the commonality of passives, and their use as a deception device, detectives in UK are now trained to spot passives, and recommended to rotate the utterance to reveal what needs to be probed (Shepherd, 2008; Shepherd & Griffiths, 2013). For example, the individuals says A mobile phone was used to set up some drug deals when rotated becomes ? used a mobile phone to set up some drug deals.