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Vol. 24. Issue 1.
Pages 1-7 (01 January 2020)
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Vol. 24. Issue 1.
Pages 1-7 (01 January 2020)
DOI: 10.1016/j.bjpt.2019.01.010
Higher order thinking about differential diagnosis
Chad E. Cooka,
Corresponding author

Corresponding author at: 2200 W. Main Street, Suite B230, Durham, NC 27710, United States.
, Simon Décaryb
a Division of Physical Therapy, Duke Clinical Research Institute, Duke University, Durham, NC, United States
b Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Faculty of Medicine, Québec, Canada

  • Diagnosis is designed to improve communication and documentation about a patient's condition and should help refine treatment options for patients. A diagnosis allows clinicians to “cross-talk” and reduce variability of care.

  • Higher order thinking is a form of thinking and learning that requires greater cognitive processing and indirectly requires different forms of learning beyond memorization, facts and, concepts. Higher order thinking occurs after one makes a diagnosis.

  • Diagnostic metrics are either internal (in that they provide information about the test only) or external (in that they provide information about post-test decision making). The best tests influence post-test decision making.

  • Overdiagnosis may lead to overtreatment. A caveat exists that over-pursuing diagnoses may lead to worse outcomes.

  • Within a diagnosis are specific phenotypes. Thus, multiple patients may have a single diagnosis but present markedly differently and respond to different outcomes.

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Tables (1)
Table 1. Common test metrics for differential diagnosis.

Differential diagnosis is a systematic process used to identify the proper diagnosis from a set of possible competing diagnoses.


The goal of this masterclass is to discuss the higher order thinking components of differential diagnosis.


For healthcare providers, diagnosis is one of many necessary components during the clinical decision making process and it is hallmarked by differentiation of competing structures for a definitive understanding of the underlying condition. The diagnostic process involves identifying or determining the etiology of a disease or condition through evaluation of patient history, physical examination, and review of laboratory data or diagnostic imaging; and the subsequent descriptive title of that finding. Whereas differential diagnosis is a varied skill set among all healthcare providers, the concept of a diagnosis is equally germane, regardless of one's background. In theory, a diagnosis improves the use of classification tools, improves clarity and communication, provides a trajectory of treatment, improves understanding of a person's prognosis, and in some cases, may be useful for preventative treatments. To achieve these improvements, one must have an understanding of relation of the clinical utility of tests and measures with diagnosis, and how to best implement these findings in clinical practice. This requires a deeper understanding (higher order thinking) of the role of diagnosis in the management of patients.

Higher order thinking


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