Some thoughts on diagnostic reasoning

23

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: https://t.co/EWwezNBhiE and a presentation that should be added to the web site tomorrow – https://www.youtube.com/channel/UCVQ3Na5zXk5lpdUfPKhZ_Ew


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

We are the best medical illustration service provider in USA. Our main office is in India. You can visit our website and check the prices of medical illustration drawings, anatomy diagrams.
We provide all illustration drawings at an affordable price.

contact : +91 9544640434
E-mail: pixmapremedia@gmail.com
Website: http://www.pixmapremedia.com/

We are the best medical drawings service provider in USA. Our main office is in India. You can visit our website and check the prices of medical illustration drawings, anatomy diagrams.
We provide all illustration drawings at an affordable price.

contact : +91 9544640434
E-mail: pixmapremedia@gmail.com
Website: http://www.pixmapremedia.com/

you have written very good content.

Excellent app. Have used this regularly and found it very easy to use. All info is readily available and the response after order placement for validation of medicines required was prompt

https://www.jaisurgicals.com/
Jai Surgicals Limited introduced its patented disposable safety scalpel into the USA market in 2002 and thereby established its pioneer status. Since then, the Organization’s commitment to its policy of contributing to the reduction of sharps injury, has led to the development of several safety scalpel solutions. Each safety scalpel solution has been developed with a focus on user preferences and Institutional budgets. Jai Surgicals Limited believes user acceptance and satisfaction is key to the reduction of sharps injury while keeping implementation costs low.

Wow! first of all very very thank you for sharing such a helpful & informative post. This post is very perfect and useful information post.

Very nice article…thanks

Excellent content! Cheers

it seems promising but how soon will such technology be spread to other parts of the world? As long as its affordable n all patients have access to it then thats not a issue. i was also able to check out the youtube channel. and shared the link with my clents too.

You always provide the best insights in your blog posts, thank you! always!

Our journey started with Divya’s observation. Divya, a mother who was quick to notice that in today’s times, a mother has only one goal, to give her child the best. Our current lifestyles don’t leave these well meaning mothers with the time to resort to age old baby care practices. Thus, O’mumsie came into existence, the brainchild of a devoted mother who wished to curate a line of new products with ancient, effective botanicals and ingredients. We at O’mumsie are well aware of the fact that advancement and technology has brought along with it the demise of purity and authenticity. Mumsie in old English means old-fashioned, and we take pride in being so! Our products are meant for future generations but with a firm grasp of our rich traditional values and herbal practices. Products that work on the fundamentals of using natural ingredients just like our great grandmothers used and did. Each product is crafted by keeping your baby’s health and nature’s wealth in mind. Our ingredients are sourced organically and in a cruelty-free environment. We work in sync with nature to source ingredients that mend well with the eco-system. We believe in delivering products from nature’s lap to your lap. You take care of your baby; we look at taking care of your’s & your baby’s products. https://www.omumsie.com/pages/about-us

really nice article the written language is very easy thanks for sharing this article.

hey, thanks, bud for writing this awesome article keep writing more content on your blog it’s really good content.

hey, this app you create really works well for the people keep doing the good work to make this more useful for the folks in the world.

Chiropractic treatment is committed to providing high quality of outpatient chiropractic services. Spinal conditions and injuries is not the only thing chiropractors can treat. We manage all neuro-musculoskeletal problems, even it is in your peripheral.
Our chiropractors have continued to learn a variety of chiropractic techniques in order to help and serve a wide range of neuro-musculoskeletal conditions and different age groups.
contact :(02) 9837 5161
E-mail:info@kingsparkchiropractic.com.au
Website:https://kingsparkchiropractic.com.au

Really good article the written language is very easy thanks for sharing this article.

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

Post a comment