Problem Solving in Clinical Medicine

Reaching a secure diagnosis is a formidable task for the medical student, which consumes many hours of history taking, physical examination, and scanning of laboratory test data. The experienced clinician who instructs students appears to arrive at a diagnosis by intuition with relative ease and only a small expenditure of time. Actually the skilled diagnostician uses a highly developed system of quickly testing hypotheses that might fit the case under consideration and eliminates all but the most probable diagnosis by careful questioning and by astute observation. This skill, or perhaps we should call it art, can be developed early in one's medical career through proper instruction, and that is what Paul Cutler's book is all about. In eight short chapters he describes the process and lays down the rules for becoming a good diagnostician. These chapters are followed by 65 case presentations that any physician will encounter in a primary