DECLARE: A Comprehensive, Multifaceted Cognitive Forcing Strategy to Confront Complex Cases

Abstract

Diagnostic excellence is an important goal in medicine. The enhancement of clinical reasoning skills of physicians, which is at the core of this concept, is a significant challenge. To achieve this improvement, it is necessary to enhance the ability to collect patient history information and to integrate the information. Additionally, the complexity of diagnosis is confounded by biases, noise, uncertainty, and contextual factors, and the impact of these factors is particularly prominent in complex cases. In such cases, the dual process theory, which is a classical reasoning measure, alone is insufficient to cope with these challenges, and a multifaceted and comprehensive approach is required to supplement its limitations. Therefore, the author presents six concrete steps, represented by the acronym DECLARE (Decomposition, Extraction, Causation Link, Assessing Accountability, Recomposition, Explanation and Exploration), that implement the concept of cognitive forcing strategy that has been shown to be effective in bias control, and include reflection, meta-cognition, and the recently popularized decision hygiene procedure. DECLARE is a strategy that should be deployed when faced with more complex diagnostic scenarios. By examining each of the six steps that comprise DECLARE individually, cognitive load can be reduced. Furthermore, by verifying causation and accountability when constructing diagnostic hypotheses, biases can be mitigated, which can also help to address noise and uncertainty, leading to an improvement in the quality of diagnosis and effectiveness in medical education.

History information management strategy for minimising biases and noise for improved medical diagnosis

“…Furthermore, to mitigate potential bias when contextual information is misleading (eg, patients inaccurately recall or provide their medical history and exposure details), sharing and verifying detailed information (medical history and the working diagnosis), aiming for story consistency and coherence, with the patient in light of patient collaboration and patient centredness should enhance the accuracy of this information. 9 …”

“…Furthermore, to mitigate potential bias when contextual information is misleading (eg, patients inaccurately recall or provide their medical history and exposure details), sharing and verifying detailed information (medical history and the working diagnosis), aiming for story consistency and coherence, with the patient in light of patient collaboration and patient centredness should enhance the accuracy of this information. 9 Diagnosis requires comprehensive assessments, incorporating medical history, physical examination and diagnostic test results at the right time. Further research is warranted to support the findings of this article that bias should be minimised using cognitively informed strategies, such as LSU-E.…”