Introduction:

Question 1

What are the 4 steps of the diagnostic process?

Answer 1

1. Information gathering.
2. Integration and interpretation.
3. hypothesis.
4. treatment.

Question 2

What is history taking?

Answer 2

• they are questions asked of the patient.
• high diagnostic value and relatively inexpensive and harmless.

Question 3

what is the first step of the diagnostic process and what does it include?

Answer 3

• obtain some information from the patient.
• history taking.
• patient-centred interviewing.

Question 4

what is step 2 of the diagnostic process?

Answer 4

• consider what might be going on and what information you still need in order to take action.
• this include; illness scripts, differential diagnosis, evidence, testing thresholds and treatment thresholds.

Question 5

what is the 3rd step of the diagnostic process?

Answer 5

• get the information mentioned in step 2.
• history taking, patient-centered interviewing and physical exams.

Question 6

What is step 4?

Answer 6

• take appropriate action.
• using; testing thresholds, treatment thresholds, probability and evidence.

Question 7

what items does history taking include?

Answer 7

• different aspects of the patients presenting concerns.
• current medications.
• past medical history.
• family history.
• social history; occupation, diet, relationships.

Question 7

what items does history taking include?

Answer 7

• different aspects of the patient presenting concerns.
• current medications.
• past medical history.
• family history.
• social history; occupation, diet, relationships.

Question 8

Why is history taking subjective?

Answer 8

• because we are acknowledging the symptoms of the client.
• a manifestation of the disease reported by the patient.

Question 9

What is patient centred interviewing?

Answer 9

• A method that focuses on a patient’s ideas and feelings about their illness.
• the impact that their condition has on their functioning and their expectations.

Question 10

why is patient centred interviewing important?

Answer 10

• people don’t just seek help for their symptoms context matters.
• you will be a better clinician if you understand the personal and emotional context of a patient’s concerns.
• not just diagnostically but allowing the patient to tell their story is therapeutic.
• listen to the patient, he is telling you the diagnosis.

Question 11

What are physical exams?

Answer 11

• inspection, auscultation (listening), percussion, palpation and other maneuvers to gather information.

Question 12

why are physical exams objective in nature?

Answer 12

• because it is a manifestation/sign of disease that the clinician percieves.

Question 13

what is a differential diagnosis?

Answer 13

• a list of conditions that are candidates for explaining the patient’s concerns.

Question 14

why are beginners often biased when diagnosing?

Answer 14

• They tend to go off of their initial thought about what the patient has which is subject to bias–> it is too often wrong.
• this is known as premature closure.

Question 15

What is premature closure?

Answer 15

• failing to consider reasonable alternatives after an initial diagnosis is made.

Question 16

What is an illness script?

Answer 16

• in expert clinicians; clinically relevant memory is accessed in patterns termed illness scripts.

Question 17

what does an illness script include?

Answer 17

• knowledge recalled as illness scripts have a relatively consistent structure which includes; predisposing conditions, clinical features and mechanisms of illness.

Question 18

what are illness scripts good for?

Answer 18

• comparing and contrasting conditions.

Question 19

what are patient illness scripts good for?

Answer 19

• facilitating a differential diagnosis.

Question 20

What is probability used in diagnosis?

Answer 20

• we need to consider how likely conditions are in order to make decisions about what to do.

Question 21

are people good at probability without training?

Answer 21

NO

Question 22

what do we need to update as we continue our diagnostic processes?

Answer 22

• update estimates of probability as more information is obtained.

Question 23

What is the evidence?

Answer 23

• information that helps you update your estimates of probabilities.

Question 24

How do we obtain evidence?

Answer 24

• it is gathered from the patient history, physical exams and further testing.

Question 25

How is evidence represented?

Answer 25

• well- represented with likelihood ratios (LR)

Question 26

what is testing and treatment thresholds?

Answer 26

• It is the point where we as clinicians decide to stop gathering information.
• thresholds and probabilities beyond which one will take certain actions and/or stop gathering information.
• like a diagnostic finish line.

Question 27

does a clinician every reach 100% certainty that a patient does or does not have a condition?

Answer 27

NO

Question 28

What does the diagnostic process entail?

Answer 28

• gathering and interpreting information and re-considering different hypotheses in light of this information.