In routine cases, experienced physicians immediately recognize the correct diagnoses. The direct retrieval of relevant knowledge is an automatic non-analytical process that is often referred to as pattern recognition.(1;2) This immediate understanding of a patient’s problem in diagnostic terms is based on an automatic information integration process such as categorization and problem representation(2-4) or on the instant recognition of similarity to a previously seen case stored in memory.(1;5)

In general practice, contextual factors such as age, gender, prior medical history, drug use, family history and social context play an important role in generating accurate diagnostic hypotheses since they may make the presence of a disease more likely or less likely.(6) GPs’ contextual knowledge is a major diagnostic tool in recognizing disorders.(7-9)

(1) Norman GR, Eva K, Brooks LR, Hamstra S. Expertise in Medicine and Surgery. In: Ericsson KA, Charness N, Feltovich PJ, Hoffman RR, editors. The Cambridge Handbook of Expertise and Expert Performance.New York: Cambridge University Press; 2006. p. 339-54.

(2) Elstein AS, Schwarz A. Clinical problem solving and diagnostic decision making: a selective review of the cognitive literature. BMJ 2002 Mar 23;324(7339):729-32.

(3) Bordage G. Prototypes and semantic qualifiers: from past to present. Med Educ 2007 Dec;41(12):1117-21.

(4) Van de Wiel M, Boshuizen HPA, Schmidt H. Knowledge restructuring in expertise development: Evidence from pathophysiological representations of clinical cases by students and physicians. Eur J Cogn Psych 2000;12(3):323-55.

(5) Norman G, Young M, Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Educ 2007 Dec;41(12):1140-5.

(6) Hobus PP, Schmidt HG, Boshuizen HP, Patel VL. Contextual factors in the activation of first diagnostic hypotheses: expert-novice differences. Med Educ 1987 Nov;21(6):471-6.

(7) Lykke K, Christensen P, Reventlow S. “This is not normal … “–signs that make the GP question the child’s well-being. Fam Pract 2008 Jun;25(3):146-53.

(8) Hjortdahl P. The influence of general practitioners’ knowledge about their patients on the clinical decision-making process. Scand J Prim Health Care 1992 Dec;10(4):290-4.

(9) Jones I, Morrell D. General practitioners’ background knowledge of their patients. Fam Pract 1995 Mar;12(1):49-53.