Flashcards in Exam 1 - Developing a Differential Diagnosis- Intro to Clinical Decision Making Deck (19):
How to take meds, what the condition is all about, prognosis, follow up visits, etc.
Critical thinking: Clarity
Need to understand what the patient is asking or trying to tell you.
“Could you elaborate further?”
“Could you give an example?”
Critical thinking: Accuracy
Needs more definition
“Is that really true?”
Can that really happen?
7 Standards of Critical Thinking
Critical thinking: Precision
The patient needs to be as exact as possible.
“Could you be more specific?”
Critical thinking: Relevance
The patient needs to give you information that has something to do with the problem you are trying to solve.
How does that have anything to do with this?
Critical thinking: Depth
Need information that is more than just superficial.
Are you just scratching the surface then stopping?
Are you dealing with the entire complaint?
Does your proposed solution take into account all the complexities of the problem?
Are you being complete and thorough?
Critical thinking: Breadth
Did you look at the problem from other points of view?
Were you showing bias?
Critical thinking: Logic
Does this make sense?
“You stated this previously, now you are saying something different; how can they both be true?”
Development or Formulation of the Differential Diagnosis (DDx)
The process of determining possible causes of the patient’s problem (symptoms) before making a diagnosis.
Involves the creation of a list of possibilities.
Diseases, Processes, Syndromes
This list contains the most common causes of the patient’s symptom(s).
Why is the DDx list important?
Differentiate between two or more conditions, diseases, processes, or syndromes.
These are the “possibilities” (possible diagnoses)
Narrow these down to a probability.
>Determine the “likelihood” that one of the possibilities is the “probable” cause (diagnosis)
Development of DDx - 10 steps
1. Observe the patient for obvious signs.
2. Start a proposed list.
3. Obtain a history to elicit symptoms.
Continue your list of possibilities.
4. Exam the patient for signs.
5. Signs coupled with symptoms will allow you to shrink or grow your list of possibilities.
6. Verify or negate possibilities based on the data gathered.
7. Continually narrow down the list of possibilities.
8. Establish the strong probable cause that will be treated.
10. Formulation of a differential diagnosis
To formulate a ddx:
Must know the anatomy.
Must understand organ systems.
Must understand pathopysiological mechanisms of disease.
Patient eval: General Survery
Apparent state of health
Signs of distress
Attitude, willingness to cooperate
Posture, height, build, weight, skin lesions, rashes
Motor activity, facial expression
Personal hygiene, odors
Assessing the patient's problematic side:
Examine the “normal” side before the “complaint” side.
Left ear pain? Assess right ear first.
Focused or complete physical examination?
Which diagnostic studies should be performed to confirm or negate your suspicions?
CBC, chemistries, coags, cardiac enzymes
Urinalysis, wet prep, cultures
Xray, CT scan, MRI, US, doppler studies
Prepare the differential based on:
Chief complaint, presenting symptoms.
Physical exam findings.
Any diagnostic data.
Why do missed diagnoses happen?
Physical signs are not recognized.
Did not listen to the patient.
Did not think the problem through correctly or thoroughly.
Patient’s complaint had nothing to do with the actual problem.