Introduction: Flashcards
What are the 4 steps of the diagnostic process?
- Information gathering.
- Integration and interpretation.
- hypothesis.
- treatment.
What is history taking?
- they are questions asked of the patient.
- high diagnostic value and relatively inexpensive and harmless.
what is the first step of the diagnostic process and what does it include?
- obtain some information from the patient.
- history taking.
- patient-centred interviewing.
what is step 2 of the diagnostic process?
- 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.
what is the 3rd step of the diagnostic process?
- get the information mentioned in step 2.
- history taking, patient-centered interviewing and physical exams.
What is step 4?
- take appropriate action.
- using; testing thresholds, treatment thresholds, probability and evidence.
what items does history taking include?
- different aspects of the patients presenting concerns.
- current medications.
- past medical history.
- family history.
- social history; occupation, diet, relationships.
what items does history taking include?
- different aspects of the patient presenting concerns.
- current medications.
- past medical history.
- family history.
- social history; occupation, diet, relationships.
Why is history taking subjective?
- because we are acknowledging the symptoms of the client.
- a manifestation of the disease reported by the patient.
What is patient centred interviewing?
- 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.
why is patient centred interviewing important?
- 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.
What are physical exams?
- inspection, auscultation (listening), percussion, palpation and other maneuvers to gather information.
why are physical exams objective in nature?
- because it is a manifestation/sign of disease that the clinician percieves.
what is a differential diagnosis?
- a list of conditions that are candidates for explaining the patient’s concerns.
why are beginners often biased when diagnosing?
- 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.
What is premature closure?
- failing to consider reasonable alternatives after an initial diagnosis is made.
What is an illness script?
- in expert clinicians; clinically relevant memory is accessed in patterns termed illness scripts.
what does an illness script include?
- knowledge recalled as illness scripts have a relatively consistent structure which includes; predisposing conditions, clinical features and mechanisms of illness.
what are illness scripts good for?
- comparing and contrasting conditions.
what are patient illness scripts good for?
- facilitating a differential diagnosis.
What is probability used in diagnosis?
- we need to consider how likely conditions are in order to make decisions about what to do.
are people good at probability without training?
NO
what do we need to update as we continue our diagnostic processes?
- update estimates of probability as more information is obtained.
What is the evidence?
- information that helps you update your estimates of probabilities.
How do we obtain evidence?
- it is gathered from the patient history, physical exams and further testing.
How is evidence represented?
- well- represented with likelihood ratios (LR)
what is testing and treatment thresholds?
- 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.
does a clinician every reach 100% certainty that a patient does or does not have a condition?
NO
What does the diagnostic process entail?
- gathering and interpreting information and re-considering different hypotheses in light of this information.
