……. diagnostic success may be a result of processes that can never be described by the clinician. If the right diagnosis arises from pattern recognition, clinicians are unlikely to be able to tell you why they thought the patient had gout, any more than we can say how we recognise that the person on the street corner is our son. Bowen claims that “strong diagnosticians can generally readily expand on their thinking”; I believe, instead, that strong diagnosticians can tell a credible story about how they might have been thinking, but no one, themselves included, can really be sure that it is an accurate depiction.
Geoffrey Norman, N Engl J Med 2006; 355:2251-2252