Would podiatrists benefit from an expert system for clinical reasoning and diagnosis? A study using laddering

Background: Computer expert systems may be of benefit to podiatrists in assisting in diagnosis. However little is known about how podiatrists use certain forms of clinical reasoning in making a diagnosis. Objectives: To investigate the mechanisms used by podiatrists in the process of clinical reasoning and whether a computer expert system may aid the process of diagnosis. Method: Laddering was used on a random sample of 12 podiatrists to find why podiatrists use certain mechanisms of clinical reasoning to make a diagnosis. Each podiatrist was interviewed by telephone and the information recorded to audio tape. A content analysis of the laddering data produced a hierarchical value map for clinical reasoning. Results: The hierarchical value map suggested that the podiatrists rely on tacit knowledge and highly schematized knowledge for their clinical decision making. It was concluded that a computer expert system is not the best technology for clinical decision making in this context