Advances in Health Sciences Education

, Volume 14, Supplement 1, pp 7–18 | Cite as

Thinking about diagnostic thinking: a 30-year perspective

  • Arthur S. ElsteinEmail author


This paper has five objectives: (a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; (c) to summarize criticisms of the hypothesis-testing model and to show how these led to greater emphasis on the role of clinical experience and prior knowledge in diagnostic reasoning; (d) to review some common errors in diagnostic reasoning; (e) to examine strategies to reduce the rate of diagnostic errors, including evidence-based medicine and systematic reviews to augment personal knowledge, guidelines and clinical algorithms, computer-based diagnostic decision support systems and second opinions to facilitate deliberation, and better feedback.


Clinical judgment Problem solving Clinical reasoning Cognitive processes Hypothetico-deductive method Expertise Intuitive versus analytic reasoning 



An earlier version of this paper was presented as a keynote address at a conference, “Diagnostic Error in Medicine,” held in Phoenix, AZ, May 31-June 1, 2008. I thank the organizing committee—Eta Berner, Pat Croskerry, Mark Graber, and Gordon Schiff—for the invitation and for encouraging personal reflections on the subject. My co-authors and students have taught me a great deal. I owe much to my colleagues in the field, some cited in this paper and some not. Errors of facts and interpretation are my sole responsibility.


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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Department of Medical EducationUniversity of Illinois at ChicagoChicagoUSA

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