Things that bug me 4 – inadequate specification of symptoms or diagnoses


Category : Medical Rants

  1. The patient had diarrhea last night.
  2. The patient complains of chest pain.
  3. The patient has diabetes (or CKD or heart failure).

What do these 3 sentences have in common?  When I hear them or read them, I want to know more!

Perhaps explaining what I want to know will make the point clear.

  1. Please describe the diarrhea – how many?  watery or loose?  incontinence? exactly when did it start?  does it persists?
  2. Where is the chest pain?  What is the characteristic of the pain?  Does it radiate?  How long does it last? …
  3. How long as the patient had diabetes, and which flavor of diabetes does h/she have?  What medications does the patient take for the diabetes? What is the last HgbA1c? What stage CKD does the patient have and what caused the CKD?  Define the heart failure (systolic dysfunction, preserved ejection fraction, etc.) and specify how severe it is?

Am I expecting too much?  Obviously I do not think so.  A good history, and therefore a good presentation gives me the information that I need to consider a differential diagnosis.  Without adequate specification, I am lost, and will make more diagnostic errors, and order unnecessary tests.

We should all work with our learners to make certain that their presentations have adequate specification.  I make this point repeatedly when I start my teaching rotations.  Yet I often have to re-emphasize these points.

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