Some thoughts on diagnostic reasoning


Category : Medical Rants

Yesterday I tweeted about our success in making some worthwhile diagnoses in the category of unusual presentations of common diseases. As I consider these successes, the principles of diagnostic aggressiveness become central to my thoughts.

For arguments sake let’s imagine three types of diagnostic reasoning. The first occurs when there is no diagnosis but we know something is wrong. These patients generally require a broad differential and much clinical thought. We often go back and collect more history, repeat the physical exam and think broadly about labs and imaging. We often need several consultants and often biopsies.

The second version includes the majority of patients – a straightforward diagnosis. We need not spend much time on diagnosis unless the respond to treatment raises warnings that we might have the wrong diagnosis.

The third version involves patients whose presentation involves some subtleties. These are the patients who too often do not stimulate diagnostic curiosity. Yet

, when we pay attention to the subtle clues, we often reopen the diagnostic process. The most fulfilling diagnoses that I and my teams have made occur in this latter category.

This fits an Osler quote, “The value of experience is not in seeing much, but in seeing wisely.” The astute diagnostician observes a lab, or physical finding, or imaging finding that does not fit the assumed diagnosis, and has courage to question that diagnosis. Sometimes the trigger finding does not yield a new diagnosis, but we still have the responsibility to wonder

, think, and pursue another diagnostic possibility.

We have presented 2 such cases in our @unremarkablelab YouTube videos: and a presentation that should be added to the web site tomorrow –

Comments (23)

Diagnostic Reasoning, also known as DxR, is patient-simulation software that analyzes a user’s ability to diagnose a problem correctly and to recommend appropriate therapy.

Great read about life & patience.

For the purpose of diagnosing, monitoring, screening, and prognosis, in vitro diagnostic tests are essential at every step. Diagnosis is the process of finding out if a patient has a specific disease. A medical professional prescribes a test to make a diagnosis or to exclude possible illness.

This is the first important step that lead to end. This is for finding if a patient have a specific disease after that doctors start their treatment.

The challenge here is not falling down a rabbit hole and starting a huge workup for something that may be completely incidental and noncontributory to the patient’s issues. I’m stuck in the critical care world between your advice and that of our last SCCM president, Jerry Zimmerman: “Less is More”.

Great post thanks for sharing this post in your blog

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Thanks for giving this important information, People should know first their problems and then diagnose them.

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