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PubMed · 7429488

The medical problem solving process.

D P Connelly·P E Johnson
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Abstract

Understanding the medical problem solving process has implications for medical education and the effectiveness of medical services. Through adaptation to the task at hand the human problem solver is able to ameliorate the effects of inherent limitations. In adapting to the medical problem solving task demands related to diagnosis and therapy, the physician uses the hypotheticodeductive process. The process draws upon the problem solver's disease centered and data centered knowledge and can be made more effective through the use of various heuristic rules and strategies that the physician develops with increasing expertise. Additional and more refined modes of laboratory support for the medical problem solver can evolve through further understanding of the problem solving process.

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Clinical Laboratory TechniquesDecision MakingDiagnostic Techniques and ProceduresEducation, MedicalHumansInformation ServicesPatient Care PlanningProblem SolvingTherapeuticsJournal Article

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D P Connelly, P E Johnson. 1980. The medical problem solving process.. https://doi.org/10.1016/s0046-8177(80)80048-7

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Utility of follow-up tests for detecting recurrent disease in patients with malignant melanomas.

OBJECTIVE: To determine the effectiveness of follow-up tests for signaling recurrences in patients with intermediate- and high-risk malignant melanomas treated with curative intention. DESIGN: Retrospective analysis of prospectively collected data. SETTING: North Central Cancer Treatment Group. PATIENTS: A total of 261 patients with resected local (> or = 1.69 mm) and regional nodal malignant melanomas who were enrolled in a single prospective adjuvant trial were studied. All patients were scheduled to be followed up monthly for 2 months, then every 2 months for the first year, every 4 months the second year, every 6 months the next 3 years, and annually thereafter, with each visit consisting of a history, physical examination, complete blood cell count, blood chemistry panel, and a chest x-ray. RESULTS: Of the 145 evaluable patients who developed recurrent melanomas, 99 patients (68%) developed symptoms that signaled the diagnosis of recurrent disease. Physical examination of asymptomatic patients led to the diagnosis of recurrent disease in 37 patients (26%). The other nine patients (6%) with recurrent disease had abnormal chest x-rays. Laboratory results were never a sole indicator of recurrent disease. CONCLUSION: The majority of recurrences following resection of primary melanomas are discovered by history and/or physical examination despite the frequent use of other follow-up tests. The present data indicate that routine blood analyses and chest x-rays have limited value in the postoperative follow-up of patients with resected intermediate- and high-risk melanomas.

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