General discussion 229 7 integrated into a testing pathway, such as a diagnostic pathway that includes patient history and physical examination, rather than standing on its own. It is important to acknowledge that testing evaluation in a scientific or guideline development manner occurs in a simplified version of reality. Guideline developers should be aware of this and incorporate real-life practical aspects into their considerations and recommendations. This may be increasingly important when looking to the future, particularly as algorithms and genomics-based personalised medicine emerge. From guidelines to practice Moving from evaluating the test-management pathway in the context of guideline development to the impact of guideline recommendations on healthcare related testing on people-important outcomes in practice, effective implementation strategies are crucial. Guidelines can only be effective if they are able to change the behaviour of healthcare professionals and consumers. The implementation of guidelines involves the use of various tools, that target different aspects of implementation, such as dissemination, understanding, adoption, and putting into practice [24]. Two aspects that deserve special attention are highlighted in the following sections: the diagnostic process and patient/public information. Diagnostic process In healthcare practice, the diagnostic process is an empirical and iterative process [25]. It involves both inductive and deductive elements, based on Bayes’ theorem [26]. Generally inductive processes, such as routine testing, can be seen as hypothesis generation. Additionally, deductive processes, such as specific testing, can be seen as hypothesis testing, to confirm or rule out a specific diagnosis. This entire diagnostic process in the consultation room is known as the hypothetico-deductive method [27, 28]. The diagnostic process involves uncertainty, including the interpretation and integration of information, the formulation of diagnoses, and communication with patients. However, it is important to note that patients and healthcare professionals experience different aspects of uncertainty. Patients are often unaware of uncertainties in the diagnostic process [29]. To manage diagnostic uncertainty, healthcare professionals frequently use patient-centred communication strategies, such as empathy, and diagnostic reasoning strategies, such as exclusion of serious diagnoses. Patient reactions and experiences related to diagnostic uncertainty are mixed, indicating variable tolerance for uncertainty [30].
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