The quality of the diagnostic effort in medicine is the chief determinant of the accuracy and precision of all the clinical acts that follow, especially formulation of therapeutic plans, construction of prognostic estimates, collection of instances of disease for study, and appreciation of the public health implications of illness. Despite this central role of diagnosis, teaching of the diagnostic process in our medical schools and house staff training programs has been relatively unorganized.
In large measure, this derives from the fact that diagnosis does not lend itself to a didactic approach, but is best taught by example. An additional difficulty arises when the student, in observing the senior clinician at the bedside, finds that the details of the teacher's thinking are compressed in the discussion that follows. Thus, the broad outlines of a diagnostic approach may be made clear, but the process by which such outlines are derived may remain