Cognitive and organizational aspects of medical diagnostic reasoning

This paper addresses the use of oral and written communication in an area where the investigator's expertise often is exceeded by the knowledge base of informants. The education of medical “house staff (fourth year medical students, interns, residents and training fellows) in a teaching hospital provides an opportunity to study the contribution of patient‐physician communication to medical diagnostic reasoning. The training of house staff occurs within an organizational framework in which hierarchical relationships become the basis for deciding when and which medical personnel are likely to see a patient, as well as the kinds of oral and written accounts that will be produced on each patient.