Liberal Arts Blog — How Doctors Think— “I am tired of living in pain all the time” (Part 2)
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 Two)
So, back to Luisa, the patient with the constant abdominal pain that’s driving her nuts. This is 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. Part One of Luisa’s case covered the first three steps of my ten-step model of physician practice: 1.) the HPI (history of present illness, which is the patient’s story ), 2.) Differential #1 (list of possible diagnoses based on HPI), then 3.) the ROS (review of symptoms — the doctor’s chance to ask questions). Today, Step Four (Differential #2 (list of possible diagnoses post ROS). Step Five: Detailed family and social history. Step six step — differential #3 — list of possible diagnoses culled in light of step four). Experts — please chime in. Correct, elaborate, elucidate.
STEP FOUR — DIFFERENTIAL # 2 — post Review of Symptoms
1. GI, Respiratory, Urinary, muscular problems no longer seem likely based on ROS — no coughing, no fever, no nausea, no vomiting, no pain during urination, no pain when she moves.
2. Could be psychological.
3. Could be neurological.
4. Could be gynecological.
STEP FIVE: THE DETAILED FAMILY AND SOCIAL HISTORY
1. No personal or family history of gut problems.
2. Nothing else relevant from parental history.
3. No siblings.
4. Was a librarian before the pain caused her to quit her job.
STEP # 6 DIFFERENTIAL #3 — Post History. No change.
NEXT WEEK: Step Seven — the physical exam. Step Eight — differential #4 — adjusted for data from physical, Step Nine — Tests, Labs, Imaging, Which of you physicians will come up with the correct diagnosis first? Let’s find out. But premature diagnosis will eliminate you from the competition. And could kill the patient. Wouldn’t this make a great prime time game show? Source: Roy Benaroch, Medical School for Everyone: Grand Rounds Cases
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.