Summary
This review (part 1 of 2) from New York in the USA is concerned with the heuristic techniques ('heuristics') used to make diagnoses. A heuristic approach to problem‐solving is one that relies on a practical method rather than a logical one. Examples include a 'guesstimate', 'unwritten rule', 'gut feeling' or just recognising something. Heuristics often work as shortcuts in the way a diagnosis is made. One way in which doctors make diagnoses is from experience: experienced doctors instantly recognise psoriasis because they have seen lots of it; they don't need to tick off every feature every time. If the diagnosis is not immediately obvious, then they may switch to a more logical approach, such as putting together a set of clinical signs. The first method is simpler and quicker but more prone to errors, especially in the hands of the inexperienced. The inexperienced may, therefore, be obliged to use the second method, sometimes laboriously. Often we use a mixture of the two, but we make mistakes with both: a proportion of the consistent level of incorrect diagnosis in medicine may be due to our own thinking processes. Over forty types of heuristic are listed. If doctors have already reached a diagnosis, for example, they may stop prematurely, ignore more subtle information and fail to consider alternatives (the 'anchoring heuristic'). For dermatologists, heuristics including colour, site, shape and texture are important, but 12 images illustrate how they can be led astray. Humans do better with purely visual information, which seems good news for radiologists and histopathologists.
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