What is the Gestalt clinical scoring system for pulmonary embolism?

Updated: Dec 28, 2018
  • Author: Kamran Boka, MD, MS; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Answer

Until now, little evidence-based literature exists analyzing a physician’s approach to a patient with suspected pulmonary embolism. Clinical scoring systems, such as the Wells and the revised Geneva score, have outlined the “what to look for” in medical decision-making, but not the “how to look for.” Emerging evidence worthy of mention illustrates that a physician Gestalt may perform better than sole reliance on clinical scoring systems. [14]

This new body of research illustrates the German concept of Gestalt theory, a philosophical and psychiatric principle in which the process is taken into consideration versus the content—in other words, the whole is not the sum of its parts, but greater than the sum of its parts. A physician’s clinical judgment should not be replaced by clinical scoring systems, but should instead be used in conjunction with evidence-based validated systems when deciding the most likely diagnosis for a patient.

It should be noted that clinical Gestalt requires clinical experience and therefore is highly variable between providers. For example, the results of a decision comparing clinical Gestalt between a new intern and a seasoned clinician with a decade of experience is not expected to be the same when compared with a validated scoring system.


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