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To extend the understanding of the clinical problem-solving process, we have analyzed the tape-recorded behavior of experienced clinicians engaged in "taking the history of the present illness" from a simultated patient. We showed that specific diagnostic hypotheses were generated often with little more information than presenting complaints, that testing of diagnostic hypotheses consisted of various case-building strategies for corroborating and discrediting hypotheses, and that the process of information gathering included techniques to evaluate the validity of data and assess the need for immediate action. Overall strategies were more difficult to discern but included a focused approach, a systemic exploration method, and a chronologic technique. The data have potential value in medical education and in developing computer programs to simulate the diagnostic process.

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In important areas of the public sector, client service depends on cooperation and collaboration among workers in different organizations or agencies. Examples include social services, education and health care. By sharing knowledge across organizations, workers can improve the quality of the service they provide. Technology to facilitate this knowledge sharing is widely available and a number of businesses have demonstrated how to put it to productive use. But the diffuse nature of many public sector settings imposes particular demands on knowledge management. Here I recount two experiments to promote knowledge sharing in the public sector: an early, unsuccessful effort to link social services workers; and a recent, substantially more successful undertaking to interconnect a large number of public school teachers. These experiences suggest the considerable potential of knowledge sharing in the public sector and underscore some of the challenges faced in that arena.

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