Introduction Class and Illness Scripts (Class 1&2) Flashcards
List the three steps of the diagnostic process
- hypothesis
- information gathering
- integration and interpretation
a manifestation of disease reported by the patient
a symptom
corresponds with history-taking
- Information from the history is often charted as _________ notes
subjective
Method that focuses on patients’ ideas and feelings (especially fears) about their illness, as well as the impact their condition has on their functioning and their expectations
patient-centred interviewing
Inspection, auscultation (listening), percussion, palpation and other maneuvers to gather further information
Physical Exams
manifestation of a disease that the clinician perceives
a sign
- corresponds with physical exam
Information from physical exams is often charted as _______ notes
objective
A list of conditions that are candidates for explaining the patient’s concerns
Differential Diagnosis
failing to consider reasonable alternatives after an initial diagnosis is made
premature closure
In expert clinicians, clinically-relevant memory is accessed in patterns termed
illness scripts
______ scripts to learn and to compare and contrast conditions
Disease illness
______ scripts, to facilitate differential diagnosis
Patient illness
Need to consider how likely different conditions are in order to make decisions about what to do
- people don’t seem to do this well without training
Probability
- Information that helps you update your estimate of probabilities
- Gathered from the patient history, physical exam and further testing
Evidence
The value of a piece of evidence is well-represented by a ________
likelihood ratio (LR)
________ are probabilities beyond which one will take certain actions and/or stop gathering information
- Like a diagnostic “finish line”
Thresholds
The ___________________ involves gathering and interpreting information, and (re-)considering different hypotheses in light of this information
diagnostic process
Components of a disease illness script
- epidemiology
- time course
- clinical presentation (signs, symptoms)
- mechanisms/pathophysiology
epidemiology (3)
demographics: age, sex, race/ethnicity, socioeconomic status
risk factors: pre-existing conditions
exposures: travel, occupational, medication, hobbies, sexual, drugs, close contacts
time course
duration: hyperacute, acute, subacute, chronic
persistence/pattern
constant: stable progressive
episodic: waxing and waning, intermittent
Clinical Presentation
The most important signs and symptoms
What constitutes a high-quality disease illness script (2)
- it uses medical terminology and categories
- it will change over time with experience and research
How do you process a disease illness script?
Problem Representation
- create a problem list
- process the list
- emphasize the most valuable evidence and de-emphasize less important valuable evidence
- abstract the patient’s concerns into medical language
- finalize the problem representation in a way that it can be compared with disease illness script
A concise representation of the patient’s concern that allows matching with a disease illness script
Patient Illness Scripts
what are the components of a patient illness script?
- epidemiology
- time course
- clinical presentation (syndrome statement)
- other important medical history
Clinical Presentation
Focus on most important signs and symptoms
what do you exclude in the clinical presentation section of a patient illness script?
- Elements already mentioned in previous sections
- Findings of little relevance
- Past medical history that is unconnected to the chief complaint
- Previous diagnosis (unless they were clearly correct)
Steps from symptoms to a possible diagnosis
- make a patient illness script
- make a simple problem list
- make a processed problem with medical terminology
- make a patient illness script
- use disease illness scripts to make a differential diagnosis
