Liberal Arts Blog — How Doctors Think: “I am tired of living in pain all the time”
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Liberal Arts Blog — Wednesday is the Joy of Science, Engineering, and Technology Day
Today’s Topic — How Doctors Think (“Medical Mysteries”): “I am tired of living in pain all the time” (Part Three)
So, back to Luisa, the patient with the constant abdominal pain that’s driving her nuts. This is the third episode of the first in a series of case studies designed to illustrate how the thinking process of a physician replicates the basic steps of the scientific method. Gather data, come up with hypotheses, test them. Repeat. So far we’ve been through the first 6 steps of my 10 step model of physician practice. Experts — please chime in. Correct, elaborate, elucidate. Recap: Luisa has in the past been diagnosed by specialists as having irritable bowel syndrome and depression. But medication taken for each has not worked and she has stopped taking them. What could be going wrong? The ROS (“Review of Symptoms”) showed no fever, no vomiting, no nausea, no pain during urination, thereby, eliminating many suspects from the list of possible diagnoses (called “the Differential”). The family and medical history have revealed little. Time for the physical.
STEP #7 THE PHYSICAL EXAM
1. Vitals signs normal. Ditto for chest, heart, Chest clear. Ditto for eyes, ears, nose, and throat. No cardiac issues.
2. No pain on movement of legs or contraction of cardiac muscles. No pain on palpating ovaries or bladder. No rashes or legions on skin.
3. Rectal and gynecological exams deferred.
STEP #8 DIFFERENTIAL (updated post-physical)
1. Psychological
2. Gynecological
3. Lower GI
STEP #9 LABS
1. Blood tests (ESR and CRP) to test for inflammation and rule out a serious infection, cancer, or autoimmune disease. Results: normal.
2. Ultrasound of abdomen and pelvis to check out kidneys, liver, ovaries, uterus. Everything looked normal. So what is going on? Is it stress? Find out next time — when the doctor goes back to the patient to ask a few more questions. What would you ask?
Clue: what could account for the symptom of pain during defecation (dyschezia) without constipation?
Source: Roy Benaroch, Medical School for Everyone: Grand Rounds Cases
YOUR TURN
Please share the coolest thing you learned this week related to science, engineering, or technology. Or, even better, the coolest or most important thing you learned in your life related to science and engineering.
This is your chance to make someone else’s day. Or to cement in your mind something that you might otherwise forget. Or to think more deeply about something dear to your heart. Continuity is key to depth of thought
