Effectual Diagnostic Approach: A New Strategy to Achieve Diagnostic Excellence in High Diagnostic Uncertainty

Abstract

Masayuki Amano,1,2 Yukinori Harada,2 Taro Shimizu2 1Department of Generalist Medicine, Minaminara General Medical Center, Oyodo, Nara, Japan; 2Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, JapanCorrespondence: Taro Shimizu, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880, Kitakobayashi, Shimotsuga, Mibu, 321-0923, Japan, Tel [phone], Fax [phone], Email [email protected]: The accumulation of optimal decision-making is vital to achieving diagnostic excellence and preventing diagnostic errors. Diagnostic uncertainty (DU) determines the difficulty of each team member’s decision-making process, including the patient, care partners, physicians, and healthcare professionals. The diagnostic approach in the low DU is already available, while the one in the high DU still needs to be clarified. In cognitive science, Sarasvathy et al established “effectuation”, a theory of decision-making under the high-uncertainty condition, by analyzing how outstanding entrepreneurs make decisions when the future is unpredictable. Based on this theory, we developed the “effectual diagnostic approach (EDA).” This simple approach allows patients and physicians to “set” problems co-creatively, emerging the outlines of the clusters of health issues under high DU conditions. After DU declines enough, the traditional problem-solving approach will help the diagnostic team achieve the patient’s well-being. EDA will offer us a guiding principle for action in the high DU. The co-creation of the “patient as an entrepreneur” with the “physician as a co-founder” will contribute to achieving diagnostic excellence.Keywords: diagnostic excellence, diagnostic uncertainty, diagnostic error, effectuation, co-creation

Keywords

• diagnostic excellence
• diagnostic uncertainty
• diagnostic error
• effectuation
• co-creation