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David A. Nardone, MD
Veterans Administration Medical Center Oregon Health Sciences University Portland

JAMA. 1985;254(20):2890.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

In their recent article Wolf et al¹ assert that trainees should address uncertainty by searching for clinical manifestations regarding one disease as opposed to using a strategy permitting evaluation of symptoms and signs across multiple diseases. They reason that this is the result of the educational model that focuses on pathophysiological disease entities whereby the clinician has learned to recognize patterns and clusters. Although I do not necessarily disagree with their assertion or their study, I do prefer to reflect on these concepts according to two other models, previously addressed in the literature, both of which are descriptive and perhaps prescriptive in nature. In the first, Johnson et al² discuss the "breadth" vs "depth" approaches. The breadth strategy enables the clinician to maintain consideration of all major hypotheses as evaluation proceeds, whereas in the depth strategy one hypothesis is considered until disconfirmed. Other labels for . . . [Full Text PDF of this Article]

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